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Histology
Histologist
Name
First
Last
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale:
No Experience
Theory or observation only during the past 12 months
Limited Experience
Performed less than 12 times within the past 12 months and may need a review
Experienced
Performed at least once per month within the past 12 months and may need minimal assistance
Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient
Histology
No Experience
Limited Experience
Experienced
Highly Skilled
Concept of Fixation
Assist with Frozen Sectioning
QC Req and Documentation
Collection of Tissue Specimen
Bone Marrow Biopsy & Slides
Filing of Slides & Blocks
Tissue Embedding (inc small Bxs)
Running of Tissue Processor
Microtome & Disposable Blades
Principle of Hematoxylin & Eosin Stain
Decalcify Bone & Hand Tissue
Grossing Small Specimen
Storage Time of Wet Tissues
Disposal of Wet Tissues
Universal Histology Precautions
Coverslipping
Preparation of Stains/Reagents
Proper Labeling of Reagents
MOHS Sectioning
GYN Prep & Staining
Non-GYN Prep/Staining
FNA Collections
Thinprep
Electronic Documents
Special Stain Techniques
No Experience
Limited Experience
Experienced
Highly Skilled
Group I
Group II
Group III
Group IV
Group V
Signature
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