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!

Polysomnographic Technologist Skills Checklist

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This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
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First Name*	Middle Name	Last Name*
E-Mail Address*	Phone Number*

 

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 SETTINGS

1

2

3

4

 

Freestanding Sleep Clinic

 

Hospital

 

STUDY TYPES

1

2

3

4

 

Adult MSLT/MWT

 

Pediatric MSLT/MWT

 

Seizure Study

 

Research Study

 

Portable Sleep Study

 

ELECTRODE PLACEMENT - EEG

1

2

3

4

 

Standard 10-20 Hook-Up

 

Seizure Hook-Up

 

Full head Hook-Up

 

ELECTRODE PLACEMENT - BODY

1

2

3

4

 

ECG

 

Face

 

Intercostal Leads

 

Limb Leads

 

MONITORING

1

2

3

4

 

ECG

 

EEG

 

End-Tidal CO2

 

O2 Saturation

 

PLM

 

STAGING & SCORING

1

2

3

4

 

Arousal

 

Cheyne-Stokes

 

Complex Sleep Apnea

 

Hypopnea

 

Obstructive Sleep Apnea

 

Periodic Breathing

 

Respiratory Events

 

Sleep Stages

 

MASK FITTING

1

2

3

4

 

Full Face

 

Nasal Mask

 

Nasal Pillow

 

TITRATION

1

2

3

4

 

ASV

 

BiPAP

 

CPAP

 

VPAP

 

MEDICATION EFFECT ON SLEEP STUDY

1

2

3

4

 

Alcohol

 

Benzodiazepines

 

Caffeine/Stimulants

 

Opioids

 

SSRI

 

Tricyclic Antidepressants

 

EQUIPMENT

1

2

3

4

 

Nihon Kohden

 

ResMed

 

Respironics

 

Other (Specify):

 

Other (Specify):

 

Other (Specify):

 

TECHNOLOGY

1

2

3

4

 

Software (Specify):

 

Software (Specify):

 

PROFESSIONAL KNOWLEDGE AND SKILLS

1

2

3

4

 

Patient Education

 

AGE SPECIFIC/POPULATION-BASED CARE

1

2

3

4

 

Neonate/Infant

 

Toddler/Preschool

 

School Age

 

Adolescents

 

Young/Middle Adults

 

Older Adults/Geriatrics

 

EMR

1

2

3

4

 

Allscripts

 

GE

 

Bar Coding for Medication Administration

 

Cerner

 

Computer Physician Order Entry

 

Eclipsys

 

Epic

 

McKesson

 

Meditech

 

Other: Specify

 

Other: Specify

 

EMR Conversion

Yes

No

 

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

 

BLS

Yes

No

 

RPSGT

Yes

No

 

CPSGT

Yes

No

 

RST

Yes

No

 

RRT

Yes

No

 

CRTT

Yes

No

 

Other: Specify

Polysomnographic Technologist Skills Checklist, version 7

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.