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Sterile Processing
Sterile Processing Technologist
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
Central Supply Skills
No Experience
Limited Experience
Experience
Highly Skilled
Assembly and Preparation - Autoclave tape
Assembly and Preparation - Dust covers
Assembly and Preparation - Heat sealing
Assembly and Preparation - Instrument count sheets
Assembly and Preparation - Labeling
Assembly and Preparation - Linen folding
Assembly and Preparation - Packing for steam
Assembly and Preparation - Placement of instruments on trays
Assembly and Preparation - Wrapping materials
Decontamination - Cleaning equipment
Decontamination - Detergents
Decontamination - Disinfectants
Decontamination - Disposable items
Decontamination - Manual cleaning
Decontamination - Sharps
Decontamination - Soiled items
Decontamination - Washer sterilization
Processing - Bowie-Dick test
Processing - Endoscopes
Processing - Instrument counting
Processing - Prepare surgical instrument tray
Processing - Reassemble instrument sets
Processing - Sets/trays
Processing - Single instruments
Steam Sterilization - Biological monitoring
Steam Sterilization - Chart recording
Steam Sterilization - Monitoring
Steam Sterilization - Testing
TJC/OSHA
No Experience
Limited Experience
Experienced
Highly Skilled
Handwashing
Understand TJC national patient safety goals
Universal precautions
Signature
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