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MLT
Medical Lab Tech
Name
*
Full Name
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
Age Groups
No Experience
Limited Experience
Experienced
Highly Skilled
1-3 years old (Toddler)
3-5 years old (Preschool)
5-12 years old (School Age Children)
12-18 years old (Adolescents)
18-39 years old (Young Adults)
39-64 years old (Middle Adults)
64+ years old (Older Adults)
Certifications
Yes
No
ASCP MT/MLS
ASCP MLT
HEW
AMT
MLT(AAB)
Blood Bank
No Experience
Limited Experience
Experienced
Highly Skilled
Patient identification process
ABO/Rh/antibody screen and ID
Crossmatch - Immediate spin/IgG
Antigen typing
Antibody typing - Gel method
Antibody typing - Tube method
Cold agglutinins
Rhogam screening
Coombs test - Direct
Coombs test - Indirect
Cord blood evaluation
Thawing/cooling of blood products
Donor collection procedures
Issue blood product to patient care area
Emergency release
Elutions
Transfusion reaction workshop
Irradiating packed cells
Splitting a baby unit
Chemistry
No Experience
Limited Experience
Experienced
Highly Skilled
Specimen preparation
Acetone analysis
Arterial blood gas
B-12 folates
Cardiacc enzymes
Chromatography - Gas
Chromatography - Thin layer
Electrophoresis
Hormone/thyroid
Immunoassay
Osmolality
Therapeutic drug monitoring
Tumor markers
Analyzer use/troubleshooting
Review and interpretation of QC
Hematology/Coagulation
No Experience
Limited Experience
Experienced
Highly Skilled
Automated instrument use
Differential manual
Sed rate manual
Reticulocyte count
Fetal hemoglobin
RBC morphology
Platelet count
Sickle cell prep
Platelet morphology
Body fluid manual cell count
Body fluid manual diff.
Special stains (e.g. PAS, LAP, Peroxidase)
WBC stool
Semen analysis
PT/PTT/INR
D-Dimer
Fibrinogen
Factor assays
Fibrin degradation products
Thrombin time
Platelet function analysis
Immunology/Serology
No Experience
Limited Experience
Experienced
Highly Skilled
RPR/RPR titer
Rheumatoid titer
ANA
LE prep
HIV rapid
HIV antibody detection
Rubella
CMV
Microbiology
No Experience
Limited Experience
Experienced
Highly Skilled
Plating micro specimens
Reading plates
Gram stains
Kit testing - Monospot/ASP titer
Kit testing - Flu/rapid strep/RSV
Wet prep/KOH prep
AFB stain/culture
O&P
CDiff
Occult blood
Chlamydia
Processing specimens for viral/fungal cultures
Urinalysis
No Experience
Limited Experience
Experienced
Highly Skilled
Crystal identification
Macrosopic analysis
Microscopic analysis
Pregnancy testing
Phlebotomy
No Experience
Limited Experience
Experienced
Highly Skilled
Patient identification
PPE equipment (gloves, mask, etc.)
Adult venipuncture
Pediatric venipuncture
Dermal stick (finger/heel)
Butterfly draw
Arterial draw
Tube types and usage
Centrifuge operations
Bleeding time
Blood culture collections
Blood alcohol collections
Drug screening collections
Equipment List
LIS Systems
Chemistry
Hematology
Urinalysis
Coagulation
Blood Bank
Microbiology
Miscellaneous
Signature
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