Operating Room Skills Checklist
Operating Room Skills Checklist
Operating Room Skills Checklist
Level Of Proficiency
Date A = Never Performed. You have never performed the stated
task and have no experience with this type of skill.
Name B = Familiar with. You are familiar with the stated task; but you
would need more experience and practice to feel
Signature comfortable and proficient in this type of skill.
C = Experienced in. You have performed this task several
times; you feel moderately comfortable functioning
independently, but you would require a resource person
to be nearby.
Please select the column that most accurately describes your proficiency level… D = Expert. You have a performed this task frequently; you
feel comfortable and proficient in this skill; you would not
require supervision or practice.
SKILL A B C D SKILL A B C D
GYNECOLOGY: A – V Shunts
Laparoscopy Knowledge of different types of grafts
Total Abdominal Hysterectomy ORTHOPEDICS:
Vaginal Hysterectomy Emergency Trauma
Suction D & C Irrigation & Debridement of open fracture
Laser Surgery Water Pik
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OPERATING ROOM SKILLS CHECKLIST
SKILL A B C D SKILL A B C D
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