GI Lab/Endoscopy Skills Checklist

Name *

Telephone *		--

Who is your recruiter? *

Who referred you? *

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

1 = Never Performed 2 = Limited Experience 3 = Comfortable Performing 4 = Proficient

Pre/Post Procedure	1	2	3	4
Knowledge of Sedation Reversal Agents
O2 Administration
Pulse Oximetry
Scope Cleaning
Set-up of Scopes & Video Equipment
Obtain IV Access
Pre-procedure Checklist
Pre-procedure Teaching
Monitor EKG
Monitor O2 sats
Monitor VS
Use of Sedation Recovery Scale
Airway Management
Assess GI Statue Post-procedure
Assess for Gag Reflex Post EGD
Perform Post Procedure Teaching
Medications:
Antibiotics
Insulin
Conscious Sedations Medications
Sedation Reversal Agents

EQUIPMENT	1	2	3	4
Computer Charting Systems

Do you speak any languages other than English?	Yes	No

If yes, which language(s)?

I hereby certify that ALL information I have provided to Emerald, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.