RADIOLOGY_TECHNOLOGIST_ANNUAL_CLINICAL_COMPETENCY_AND_SKILLS

		RADIOLOGY TECHNOLOGIST ANNUAL CLINICAL COMPETENCY AND 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)	SETTING		1	2	3	4
0	Adult Inpatient
0	ER/Trauma
0	Adult Outpatient
0	Pediatric Inpatient
0	Pediatric Outpatient
Rating Stars (Click)	Procedures		1	2	3	4
0	Chest Studies
0	Abdominal Studies
0	Foreign Body/Soft Tissue Studies
0	Specimen Radiography
Rating Stars (Click)	Extremities		1	2	3	4
0	Upper
0	Lower
0	Pelvis Obls/Judet Views
0	Pelvis SI Joints
0	Pelvis Sacrum/Coccyx
Rating Stars (Click)	Spine		1	2	3	4
0	Cervical Spine-Obls/Flexion/Extension
0	Thoracic Spine-Swimmer’s View
0	Lumbar Spine-Obls/Flexion. Extension
Rating Stars (Click)	Head		1	2	3	4
0	Facial Bones
0	Mandible
Rating Stars (Click)	Head (cont.)		1	2	3	4
0	Mastoids
0	Orbits
0	Sinus Series
0	TMJ
0	Skull Series
Rating Stars (Click)	Tomography		1	2	3	4
0	Renal
0	TMJ
0	Spine
Rating Stars (Click)	Flouroscopy/Contrast Studies		1	2	3	4
0	Barium Swallow/Esophagram
0	Modified Barium Swallow/Protocol Swallow
0	Swallow Studies with Videotaping
0	Upper GI Series-Single Contrast
0	Upper GI Series-Air Contrast
0	Small Bowel Follow Through
Rating Stars (Click)	Enema Studies		1	2	3	4
0	Barium Enema-Single Contrast
0	Water Soluble Contrast Enema (e.g. Hypaque)
0	Barium Enema-Air Contrast
0	Lower GI Studies thru Colostomy
Rating Stars (Click)	Cystography		1	2	3	4
0	Cystogram
0	Voiding Cystogram
Rating Stars (Click)	Cystography (cont.)		1	2	3	4
0	Urethrography
Rating Stars (Click)	Contrast Injection Studies		1	2	3	4
0	IVP
0	IVP with Tomograms
Rating Stars (Click)	Myelograms		1	2	3	4
0	Cervical Spine
0	Thoracic Spine
0	Lumbar Spine
Rating Stars (Click)	Mobile C-Arm Flouroscopy		1	2	3	4
0	Broncoscopy with Fluoro Guidance
0	Bedside Line and Tube Placement
Rating Stars (Click)	OR Cases		1	2	3	4
0	Sterile Procedures in OR
0	Spine Work
0	Operative Cholangiography
0	Hip Studies
0	Extremity Studies
0	Cystography
0	Retrograde Urography
Rating Stars (Click)	Patient Safety		1	2	3	4
0	National Patient Safety Goals
0	Computerized Charting
Rating Stars (Click)	EMR		1	2	3	4
0	Epic
0	Cerner
0	Eclipsys
0	McKesson
0	Meditech
0	Other Computerized System
0	Computerized Physician Order Entry
0	Bar Coding for Medication Administration
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)	Age Specific Competencies		1	2	3	4
0	Newborn/Neonatal (birth – 30 days)
0	Infant (30 days-1 year)
0	Toddler (1-3 years)
0	Preschool (3-5 years)
0	School Age Children (5-12 years)
0	Adolescent (12-17 years)
0	Young Adults (18-44 years)
0	Middle Adults (45-64 years)
0	Older Adults (>65 years)