Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
    		•
    AGE OF PATIENTS CARED FOR
    Newborn/Neonate (birth to 30 days)
    Infant (31 days to 12 months)
    Toddler/Preschool (13 months to 5 years)
    School Age Child/adolescent (6 years to 18 years)
    Young Adults Middle Adult (19 years to 64 years)
    Older Adults/Elderly (65+ years)
    EXPERIENCE
    Hospital Laboratory
    Clinic Experience
    Blood Bank
    Hematology
    Chemistry
    Body Fluid Testing
    Coagulation
    Immunology/Serology
    Microbiology
    Basic Lab Procedures
    Basic Lab Safety
    Sources of Error in Lab Testing
    Quality Assurance in Lab Testing
    Decontamination Procedures
    Knowledge of "Do Not Use Abbreviations"
    Do you have charge/supervisor experience?
    Knowledge of current Joint Commission National Patient Safety Goals
    Knowledge/familiarity with HCAHPS scores
    Selecting Appropriate
    Type of sample for test requested
    Methods for test requested
    Reagents for test
    Media for test
    Control for test
    Instrument to perform test
    Routine procedures to verify results
    Special procedures to verify results
    Preparing Appropriate
    Samples
    Reagents
    Media
    Blood Products
    Controls
    Instruments
    Accurately calculating results of testing
    Evaluating lab Data
    Verify Test Results for reporting
    Recognize Inconsistent results
    Recognize sources of error
    Check for common procedural problems
    Check for common technical problems
    Take corrective action
    Determine Instrument adjustments
    Assess accuracy of test procedures
    Recognize abnormal results
    Recognize the need for additional testing
    Phlebotomy
    Finger stick
    Heel stick
    Butterfly
    Venipuncture
    Pediatric
    Knowledge of tube types and uses
    Manual Pipetting
    General Laboratory Practice
    Glucose tolerance testing
    Glucometer use
    Hematology
    Automated CBC
    Differential
    Manual Pipetting
    Automated CBC
    RBC morphology
    WBC morphology
    Platelet morphology
    Manual cell counts
    RBC Indices
    Tests for Hemoglobin defects
    Fetal hemoglobin
    ANC ( Absolute Neutrophil Count)
    Bone Marrow Preparation
    CSF
    Cell count
    Differential
    Retic count
    ESR (Manual or automated)
    Body Fluid Cell Count
    Sickle Cell prep
    Special stains (PAS,Peroxidase, Leukocyte Aldaline Phospatase)
    Scattergram interpretation
    Histogram interpretation
    Knowledge of alert and panic values
    Instruments used for Hematology:
    .1.
    .2.
    .3.
    Coagulation
    PT,PTT,INR
    Circulating Anticoagulants
    Thrombin Time
    Fibrinogen
    Bleeding Times (Ivy and Duke)
    Blood Bank
    ABO testing
    RH testing
    Cross match - tube method
    Cross match - gel method
    Compatibility testing
    Transfusion practices/indications
    Patient identification
    Issuing blood components
    Emergency release
    Antibody screen
    Antibody identification
    Antibody titer
    Blood irradiation
    Cell packing
    Cell washing
    Plasmapheresis
    Plateletpheresis
    Immediate spin cross match
    Freezing blood
    Thawing procedures for platelets
    Thawing procedures for FFP
    RBC's
    Platelets
    FFP
    Cryoprecipitate
    Cord blood
    Rhogam
    Rh IgG
    Coombs Test direct
    Coombs test indirect
    Transfusion adverse reaction
    Special tests (DAT,Phenotyping, etc.)
    Instruments used for Blood Bank:
    .1.
    .2.
    .3.
    Chemistry
    General chemistry
    BMP
    CMP
    Immunoassay chemistry
    Lipid Profile
    CRP
    Immunoelectropheresis
    Iron and TIBC
    Acetone analysis s (serum and urine)
    Ammonia
    Osmolality
    Blood gases
    Drug screening
    Gas chromatography
    Thin layer chromatography
    Blood alcohol level
    Electropheresis
    Immunoelectropheresis
    Immunoassay chemistry
    Tumor markers
    Therapeutic drug levels
    Toxicology
    ISE procedures
    CSF Protein
    Knowledge of alert and panic values
    Instruments used for Chemistry:
    .1.
    .2.
    .3.
    Urinalysis
    Manual UA
    Automated UA
    Microscopic UA
    24 hour urine collection
    Urine pregnancy test
    Semen analysis
    Crystal identification
    Urine drug testing
    Chain of Custody documentation
    Knowledge of alert and panic values
    Instrumentation used for Urinalysis:
    .1.
    .2.
    .3.
    Immunology/Serology
    ANA
    ASO Titer
    CMV
    C3,C4, Total complement
    Rubella serology
    MMR serology
    Hepatitis
    HIV
    Influenza screen A and B
    Meningitis screen
    Monospot
    Rapid strep
    Rheumatoid factor
    Pertussis
    pregnancy testing/HCG
    RPR
    Cold agglutinins
    Febrile agglutinins
    RSV
    H Pylori
    LE Cell Prep (Lupus)
    Mycoplasma
    Nephelometry
    PCR technology
    T and B cell studies
    TORCH studies
    ELISA testing
    Western Blot Technology
    Autoimmunity
    Cellular and Humoral
    DNA Probe Technology
    Flow cytometry
    FTA-ABS
    Hemagglutination inhibition
    Hormone testing
    Radial immuno diffusion
    Knowledge of alert values
    Instrumentation used for Immunology/Serology:
    .1.
    .2.
    .3.
    Microbiology
    Aerobic culture
    Anaerobic culture
    Aerobic gram positive cocci
    Gram stain
    Gram negative cocci
    Gram positive cocci
    Gram negative bacilli
    Gram positive bacilli
    Blood culture
    Cell culture
    Viral cultures
    Virus identification
    Virus isolation
    Fungal culture
    Chlamydia culture
    Chlamydia smear
    CO2 cultures
    Mycobacteria culture
    culture plating
    Acid fast stain (fluorescent)
    Acid fast stain (Kinyoun)
    Malarial exam
    sensitivities (KB and MIC)
    Organism identification
    India Ink
    KOH prep
    Prep and ID
    Occult blood
    C difficil assay
    Dark field
    wet mount
    Knowledge of alert values
    Instrumentation used for Microbiology:
    .1.
    .2.
    .3.
    Histology
    Concept of Fixation
    Assist with Frozen Sectioning
    Assist with Gross Sectioning
    QC Req and Documentation
    Collection of Tissue Specimen
    Bone Marrow Biopsy and Slides
    Embed Tissue (incl small Bxs)
    Running of Tissue Processor
    Microtome and Disposable Blades
    Filing of Slides and Blocks
    Principle of Hematoxylin and Eosin Stain
    Decalcify Bone and Hand Tissue
    Grossing Small Specimen
    Crypto-spin preps
    Immuno stains
    Special Stain Techniques
    Group I
    Group II
    Group III
    Group IV
    Group V
    Storage Time of Wet Tissues
    Disposal of Wet Tissues
    Universal Histology Precautions
    Coverslipping
    Preparation of Stains/Reagents
    Proper Labeling of Reagants
    MOHS Sectioning