• 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

    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
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Interpret - Accuracy of test procedures
    Interpret - Recognize and report abnormal results
    Interpret - Recognize need for additional testing
    Pediatrics - Finger stick
    Pediatrics - Heel stick
    Pediatrics - Microcapillary skin puncture
    Pediatrics - Neonatal screening
    Pediatrics - Venipuncture
    Perform - Analysis/collection of cerebrospinal fluids
    Perform - Analysis/collection (synovial, serous, semen, feces)
    Perform - Bandage to site post draw
    Perform - Basic and specialized specimen handling
    Perform - Blood alcohol measurement
    Perform - Blood cultures
    Perform - Butterfly method
    Perform - Decontamination of puncture site
    Perform - Glucometer systems
    Perform - Invert tube post draw
    Perform - Monitor/document bleeding times
    Perform - Patient greeting and test explanation
    Perform - Positioning patient
    Perform - Pressure applied to site post-draw
    Perform - Proper management and use of venipuncture supplies
    Perform - Proper ordering of specimen collection
    Perform - Proper patient identification
    Perform - Proper use and management of blood culture bottles
    Perform - Proper waste disposal and use of sharps container
    Perform - Specimen identification and labeling
    Perform - Successful transport of specimen to lab
    Perform - Syringe method
    Perform - Test requisitions
    Perform - Therapeutic drug monitoring
    Perform - Tourniquet application and removal
    Perform - Understand tube coloring system
    Perform - Urinalysis - Chemical
    Perform - Urinalysis - Physical
    Perform - Urinalysis - Microscopic
    Perform - Vacutainer method
    Perform - Venipuncture site selection
    Perform - Warming the puncture site
    Phlebotomy complications - Edema
    Phlebotomy complications - Excessive bleeding
    Phlebotomy complications - Fainting
    Phlebotomy complications - Failure to draw blood
    Phlebotomy complications - Hematoma
    Phlebotomy complications - Infection
    Phlebotomy complications - Petechiae
    Safety - Blood borne pathogens exposure plan
    Safety - Body mechanics
    Safety - Data security
    Safety - Handwashing
    Safety - Hazardous materials and MSDS
    Safety - Patient confidentiality
    Safety - Personal protective equipment
    Safety - Universal precautions
    Special populations - Burned areas
    Special populations - Cardiac arrest patient
    Special populations - Damaged veins
    Special populations - Dialysis patients
    Special populations - Heparin locks
    Special populations - Hickman catheter
    Special populations - Mastectomy
    Special populations - Occluded veins
    Special populations - Port-a-cath
    Special populations - Scarred areas
    Special populations - Sclerosed veins
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Knowledge of radiation safety guidelines
    Knowledge of TB exposure plan
    Quality assurance
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Toddler (1-3 yrs)
    Preschool (3-5 yrs)
    School age children (5-12 yrs)
    Adolescents (12-18 yrs)
    Young adults (18-39 yrs)
    Middle adults (39-64 yrs)
    Older adults (64+ yrs)

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