Emergency Medical Technician (EMT) Checklist

NAME

LAST 4 OF SSN

Date of application

E-MAIL

I hereby certify that ALL information I have provided 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.

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.

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Skills	Rating Stars (Click)	1	2	3	4
Vital Sign - PULSE
Vital Sign - RESPIRATION
Vital Sign - LUNG SOUNDS
Vital Sign - BLOOD PRESSURE
Vital Sign - PULSE OXIMETRY
Basic Airway - OROPHARYNGEAL AIRWAY (OPA)
Basic Airway - NASOPHARYNGEAL AIRWAY (NPA)
Basic Airway - ORAL SUCTIONING
Basic Airway - BAG VALVE MASK
Basic Airway - OXYGEN ADMINISTRATION
Advanced Airway - MULTI-LUMEN AIRWAY (COMBI-TUBE)
Patient Assessment - TRAUMA
Patient Assessment - MEDICAL
Bleeding Control/Shock Management
PNEUMATIC ANTI SHOCK GARMENT (MAST)
Spinal Immobilization - B/B (SUPINE PT.)
Spinal Immobilization - KED (SEATED PT.)
Helmet Removal - FOOTBALL
Helmet Removal - MOTORCYCLE
Splinting - LONG BONE
Splinting - BIPOLAR TRACTION (HARE)
Splinting - UNIPOLAR TRACTION (SAGER)
Scoop Stretcher