CYNET_SYSTEMS_MAIN_LOGO.gif   Radiation Therapist Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

  
       
Rating Stars (Click) Radiation Therapy 1 2 3 4  
Linear accelerator  
Linear accelerator with electrons  
Superficial radiation treatment  
Ortho voltage radiation treatment  
Simulation of treatment sites  
Treatment planning  
Cobalt 60 therapy  
Hyperthermia treatment  
Strontium 90 therapy  
Dosimetry  
Calculations  
Radiation precautions  
Rating Stars (Click) Provision of treatment to patients with: 1 2 3 4  
Hodgkin’s  
Childhood cancer  
Brain cancer  
Lip & oral cavity cancer  
Oropharyngeal cancer  
Esophageal cancer  
Hypo pharyngeal  
Laryngeal  
Stomach  
Liver  
Gall bladder  
Kidney  
Endocrine  
Pancreatic  
Bladder  
Colon  
Anal  
Testicular  
Vaginal  
Vulvular  
Uterine  
Cervical  
Ovarian  
Endometrial  
Breast cancer  
Bone cancer  
Lung cancer  
Metastatic squamous cancer  
Rating Stars (Click) General Skills 1 2 3 4  
Patient / family teaching  
Care of the patient in restraints  
Lift / transfer devices  
Rating Stars (Click) National Patient Safety Goals 1 2 3 4  
Accurate patient identification  
Effective communication  
Pain assessment & management  
Infection control  
Universal precautions  
Minimize risk of falls  
Prevention of pressure ulcers  
Rating Stars (Click)  Age Specific Competencies 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration