Skills Checklist

Congratulations on your decision to apply for a Travel position with Med Travelers! Before we can offer you an employment opportunity, an electronic skills assessment must be completed. From the skills checklist below, please locate the list that matches your specialty and complete the online form. Be sure to review your information thoroughly before clicking the submit button. Thank you!

Respiratory Therapist/Pulmonary Function Technologist Skills Checklist

*

Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name*	Middle Name	Last Name*
E-Mail Address*	Phone Number*

 

 

Please mark your level of experience

1. No experience; requires education, training and supervision
2. Intermittent experience; may need support or supervision
3. Proficient; consistent experience, independent
4. Expert level; can teach/supervise others

 

WORK SETTING

1

2

3

4

 

Acute Care

 

Adult

 

Critical Care

 

Emergency Department

 

Home Health

 

LII Nursery

 

LIII Nursery

 

NICU

 

Pediatrics

 

PICU

 

Pulmonary Rehab

 

Skilled/Subacute

 

Sleep Lab

 

Transports

 

THERAPEUTICS AND PROCEDURES

1

2

3

4

 

Airway Management Devices and Suctioning

 

Assist with Intubation

 

Bronchial Alveolar Lavage (BAL)/Mini BAL

 

Bronchopulmonary Hygiene (Acapella, Percussion, etc.)

 

Comfort Flow

 

Croup Tent Set Up/Troubleshoot

 

External CPAP

 

Extubation

 

High Flow Nasal Cannula

 

Hyperinflation Therapy (Incentive Spirometer, IPV, etc)

 

Infant Hood Set Up

 

Intubate Adult Patient

 

Monitor Cuff Pressure-Airway Management Devices

 

Tracheostomy Care

 

ARTERIAL BLOOD GASES

1

2

3

4

 

Allen Test

 

Draw from Brachial Artery

 

Draw from Radial Artery

 

Insert Arterial Line

 

ISTAT

 

PULMONARY FUNCTION TESTS

1

2

3

4

 

Lung Volume by Helium Dilution

 

Lung Volume by Nitrogen Washout

 

Lung Volume by Plethysmograph

 

VENTILATOR SET UP AND CARE

1

2

3

4

 

Assist Control

 

CPAP/Pressure Support

 

Weaning

 

Non-Invasive Ventilation

 

Bilevel Ventilatory Assistance

 

High Frequency Oscillator

 

IMV/SIMV

 

Bivent

 

MEDICATIONS

1

2

3

4

 

Acetylcysteine (Mucomyst)

 

Albuterol/Proventil/Ventolin

 

Brovana

 

Inhaled Flolan

 

Inhaled Nitric Oxide

 

Inhaled Steroids

 

Lidocaine

 

Pentamadine

 

Performist

 

Racemic Epinephrine

 

Respimat MDI

 

Medication Education

 

VENTILATOR TYPES

1

2

3

4

 

Drager Infant

 

Hamilton

 

Puritan Bennett

 

Respironics

 

Servo

 

Other-Specify

 

Other-Specify

 

Other-Specify

 

EQUIPMENT AND PROCEDURES (Neonate/Pediatrics)

1

2

3

4

 

Assist in High Risk Delivery

 

Capillary Blood Gases

 

ECMO

 

O2 to Tent

 

Umbilical Blood Gases

 

OXYGEN THERAPY DELIVERY (Neonate/Pediatrics)

1

2

3

4

 

Bag and Mask

 

Nasal Cannula/Oxyhood/Tent

 

Trach Collar

 

Vapotherm

 

VENTILATOR (Neonate/Pediatrics)

1

2

3

4

 

Apnea Monitor

 

Bivent

 

Bubble CPAP

 

CPAP/Nasal CPAP/BIPAP

 

End Tidal CO2 Monitoring

 

High Frequency/Jet Ventilator

 

IMV/SIMV

 

Oscillating Ventilator

 

Pressure/Volume Ventilator

 

PROFESSIONAL KNOWLEDGE AND SKILLS

 

Do you have experience as a Lead Respiratory Therapist?

Yes

No

 

EMR Conversion

Yes

No

 

AGE SPECIFIC/POPULATION-BASED CARE

1

2

3

4

 

Neonate/Infant

 

Toddler/Preschool

 

School Age

 

Adolescents

 

Young/Middle Adults

 

Older Adults/Geriatrics

 

CERTIFICATIONS/LICENSURES/REGISTRATIONS (Current at time of completing this form)

 

BLS

Yes

No

 

ACLS

Yes

No

 

PALS

Yes

No

 

NRP

Yes

No

 

CRTT

Yes

No

 

RRT

Yes

No

 

CPFT

Yes

No

 

Other: Specify

Respiratory Therapist/Pulmonary Function Technologist Skills Checklist, version 8

You must agree with the statements at the bottom of the form before submitting your skills checklist.

Please read and agree to the statements below by marking the checkbox.

* I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. Falsification of any information provided, will result in being ineligible to travel with AMN. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.