CYNET_SYSTEMS_MAIN_LOGO.gif   SPD SHIFT MANAGER 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) Processing 1 2 3 4  
Single instruments   
Endoscopes   
Repair   
Sets/ Trays   
Care of instruments   
Other (list):   
Rating Stars (Click) Decontamination 1 2 3 4  
Manual cleaning  
Washer sterilizer  
Soiled linen  
Disinfectants   
Sharps  
Disposable items  
Cleaning equipment   
Detergents   
Dress code   
Other (list):   
Rating Stars (Click) Steam Sterilization 1 2 3 4  
Chart recording  
Biological monitoring  
Time   
Testing/ Monitoring  
Other (list):  
Rating Stars (Click) Tests   1 2 3 4  
Test control   
Recording  
Other (list):   
Rating Stars (Click) Assembly andPreparation 1 2 3 4  
Wrapping materials  
Autoclave tape  
Dust covers   
Proper towel/ linen folding  
Proper labeling  
Expiration dates  
Packing for steam  
Heat sealing  
Instrument count sheets  
Placing instruments on trays  
Other (list):   
Rating Stars (Click) KNOWLEDGE, SKILLS, ABILITIES 1 2 3 4  
Plans and organizes day-to-day operations, schedule and activities of the unit.   
Sets priorities and functional standards, gives direction to staff as necessary  
Organizes, oversees and leads work efforts to ensure best service  
Makes and executes decisions within delegated authority  
Surfaces issues to management for resolution as appropriate  
Participates in resolving issues outside delegated scope of authority  
Hires, coaches, trains, disciplines and terminates staff as necessary  
Utilizes instrument tracking system to effectively manage the flow of work  
Evaluates employees and tracks inventory data  
Participates in planning, budgeting and general management efforts  
Functions as a liaison between customer departments and SPD  
Develops and maintains effective relationship with vendors.   
Follows safety rules and reports accidents and hazards immediately to management and peers.   
Performs other duties as assigned  
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  
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 APPROPRIATE CARE 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)