Respiratory Therapist 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

General Skills	Rating Stars (Click)	1	2	3	4
Care of Patient in Restraints
Electronic Documentation
Isolation Precautions
Medicare Documentation
Patient/Family Education
Written Documentation
Care of Patients With	Rating Stars (Click)	1	2	3	4
Acute/Chronic Bronchitis
ARDS
Aspiration Pneumonia
Asthma
Atelectasis
Bacterial/Viral Pneumonia
Bronchiectasis
Broncho-Pulmonary Dysplasia
Cardiac Surgery
Congestive Heart Failure
Croup
Cystic Fibrosis
Diabetic Ketoacidosis
Emphysema
Epiglottitis
Failure to Thrive
Fem-pop Bypass
Gullian Barre
Hayaline Membrane Disease (HMD/IRDS)
Therapy and Procedures	Rating Stars (Click)	1	2	3	4
TherapApnea Monitor
Assessment of Breath Sounds
Carbogen Delivery
Diaphragmatic Breathing
Disinfection and Sterilization
End-Tidal CO2 Monitoring
Nasal-Oral Airway Placement
Oximetry
Pursed Lip Breathing
Transcutaneous Monitoring y and Procedures
Oxygen Administration:	Rating Stars (Click)	1	2	3	4
Acapella
Aerosol Set Up/Mask/Trach
Analyze Oxygen
BiPAP Nasal/Mask
Bronchial Hygiene Therapy
Chest Physical Therapy/Postural Drainage
CPAP Nasal/Mask
Continuous Medication Nebulizer
Cough Assisted machine
Croup Tent Set Up
EzPAP Expansion Therapy
Flutter Valve Therapy
Hand Held Nebulizer
Heated Aerosol Mask/Trach Collar
Heliox Delivery
Incentive Spirometry (IS)
Infant Hood Set Up
Intrapulmonary Percussive Ventilation (IPV)
Metered Dose Inhaler
Nasal Cannula
Nitric Oxide Delivery
Oxgen Tank Set Up/Change Tank
Obtaining Arterial Blood Gases:	Rating Stars (Click)	1	2	3	4
ABG Interpretation/Analyzer
Airway Pressure Release Ventilation (ARPV)
Allen Test
Arterial Blood Gas Analysis
Arterial Line Insertion
Arterial Line Maintenance
Bronchoscopies/Assist
Change
Clean Trach Tubes
Check Intracuff Pressures
Continuous Positive Airway Pressure (CPAP)
Endotracheal
Extubations
Perform Independently
Assist Only
Femoral Artery
Flow/Volume/Pressure Waveform Interpretation
High Frequency Ventilator
Independent Sychronous Lung Ventilation
Inhaler Reservoirs
Intra Aortic Balloon Pump (IABP)
Intubations
Perform Independently
Assist Only
Inverse Ratio Ventilation
Nasotracheal
Negative Inspiratory Force
Peak Flow Rat Monitoring
General Skills	Rating Stars (Click)	1	2	3	4
Care of Patient in Restraints
Electronic Documentation
Isolation Precautions
Medicare Documentation
Patient/Family Education
Written Documentation
Care of Patients With	Rating Stars (Click)	1	2	3	4
Acute/Chronic Bronchitis
ARDS
Aspiration Pneumonia
Asthma
Atelectasis
Bacterial/Viral Pneumonia
Bronchiectasis
Broncho-Pulmonary Dysplasia
Cardiac Surgery
Croup
Emphysema
Epiglottitis
Pacemakers
Thoracotomies
Tuberculosis
Therapy and Procedures	Rating Stars (Click)	1	2	3	4
Apnea Monitor
Oximetry