MEDICAL LAB TECH SKILLS EVALUATION #2 - Page 2
MEDICAL LAB TECH SKILLS EVALUATION #2 - Page 2
Personal Information
Name
*
First
Last
Title / Specialty
*
Email
*
Phone
-
(###)
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Basic Safety Guidelines
Gloves, Goggles, masks
Very Experienced
Some Experience
No Experience
Communication Skills
Very Experienced
Some Experience
No Experience
Ability to write procedures
Very Experienced
Some Experience
No Experience
Microbiology
Gram Stain
Very Experienced
Some Experience
No Experience
Acid Fast Stain (Kinyoun)
Very Experienced
Some Experience
No Experience
Acid Fast Stain (Fluorescent)
Very Experienced
Some Experience
No Experience
India Ink
Very Experienced
Some Experience
No Experience
West Mount-motility
Very Experienced
Some Experience
No Experience
Darkfield
Very Experienced
Some Experience
No Experience
KOH Prep
Very Experienced
Some Experience
No Experience
Culture Plating
Very Experienced
Some Experience
No Experience
Organism Identification (Aerobic)
Very Experienced
Some Experience
No Experience
Sensitivities
K.B.
Very Experienced
Some Experience
No Experience
M.I.C.
Very Experienced
Some Experience
No Experience
Blood Culture
Very Experienced
Some Experience
No Experience
Anaerobic Identification
Very Experienced
Some Experience
No Experience
Occult blood
Very Experienced
Some Experience
No Experience
Ova and Parasite Concentration
Very Experienced
Some Experience
No Experience
Mycobacteria
Culture
Very Experienced
Some Experience
No Experience
Concentration Techniques
Very Experienced
Some Experience
No Experience
Identification
Very Experienced
Some Experience
No Experience
Chlamydia Culture
Very Experienced
Some Experience
No Experience
Chlamydia Smear
Very Experienced
Some Experience
No Experience
Cell Culture Technique
Very Experienced
Some Experience
No Experience
Virus Isolation
Very Experienced
Some Experience
No Experience
Virus Identification
Very Experienced
Some Experience
No Experience
C Difficili Assay
Very Experienced
Some Experience
No Experience
Malarial Examination
Very Experienced
Some Experience
No Experience
Aerobic Culture
Very Experienced
Some Experience
No Experience
Serology
RPR
Very Experienced
Some Experience
No Experience
FTA-ABS
Very Experienced
Some Experience
No Experience
ANA
Very Experienced
Some Experience
No Experience
LE Cell Prep
Very Experienced
Some Experience
No Experience
C3,C4 Total Complement
Very Experienced
Some Experience
No Experience
Rheumatoid Factor
Very Experienced
Some Experience
No Experience
Monospot
Very Experienced
Some Experience
No Experience
Pregnancy Testing
Very Experienced
Some Experience
No Experience
ASP Tier
Very Experienced
Some Experience
No Experience
Radial Immuno Diffusion
Very Experienced
Some Experience
No Experience
Hemagglutination Inhibition
Very Experienced
Some Experience
No Experience
Rubella Serology
Very Experienced
Some Experience
No Experience
TORCH Studies
Very Experienced
Some Experience
No Experience
Febrile Aggulations
Very Experienced
Some Experience
No Experience
Body Fluids
Very Experienced
Some Experience
No Experience
Meningitis Screen
Very Experienced
Some Experience
No Experience
RIA
Radiation Safety Techniques
Very Experienced
Some Experience
No Experience
Background Counts
Very Experienced
Some Experience
No Experience
Data Reduction
Very Experienced
Some Experience
No Experience
Curves / Regressions
Very Experienced
Some Experience
No Experience
Thyroid Testing
Very Experienced
Some Experience
No Experience
Hormone Testing
Very Experienced
Some Experience
No Experience
Tumor Markers
Very Experienced
Some Experience
No Experience
B12/Folates
Very Experienced
Some Experience
No Experience
Hepatitis
Very Experienced
Some Experience
No Experience
Instrumentation / Gama Counters
Very Experienced
Some Experience
No Experience
Counters
Very Experienced
Some Experience
No Experience
Scintillation Counter
Very Experienced
Some Experience
No Experience
Age Specific
Newborn / Neonate (birth – 30 days)
Very Experienced
Some Experience
No Experience
Infant (30 days – 1 year
Very Experienced
Some Experience
No Experience
Toddler (1-3 years)
Very Experienced
Some Experience
No Experience
Preschooler (3-5 years)
Very Experienced
Some Experience
No Experience
School Age Children (5-12 years)
Very Experienced
Some Experience
No Experience
Adolescents (12-18 years)
Very Experienced
Some Experience
No Experience
Young Adults (18-39 years)
Very Experienced
Some Experience
No Experience
Middle Adults (39-64 years)
Very Experienced
Some Experience
No Experience
Geriatrics (64 years-older)
Very Experienced
Some Experience
No Experience
Other Skills / Credientials
Please check all those which apply
BLS
ACLS
CPR
PALS
