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Sterile Processing Tech Skills Checklist

My responses in this checklist represent a true reflection of my experience and comfort level. Please self-rate your comfort level in performing tasks in connection with the below checklist. Rate your level of comfort for each line item by following the below ranking system. Simply fill in the appropriate option immediately following the rating number.

* Typed Name (typing your name below serves as an electronic signature)

* Phone Number

* Email

* Re-enter Email

Level of Comfort/Experience

N/A=Non-applicable
1=Inexperienced in this area
2=Limited comfort/experience in this area
3=Comfortable/experienced in this area
4=Very comfortable/highly experienced in this area

Processing	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Single Instruments	N/A	1	2	3	4
Endoscopes	N/A	1	2	3	4
Repair	N/A	1	2	3	4
Sets/Trays	N/A	1	2	3	4
Care of Instruments	N/A	1	2	3	4
Decontamination	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Manual Cleaning	N/A	1	2	3	4
Washer Sterilizer	N/A	1	2	3	4
Soiled Linen	N/A	1	2	3	4
Disinfectants	N/A	1	2	3	4
Sharps	N/A	1	2	3	4
Disposable Items	N/A	1	2	3	4
Cleaning Equipment	N/A	1	2	3	4
Detergents	N/A	1	2	3	4
Dress Code	N/A	1	2	3	4
Steam Sterilization	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Chart Recording	N/A	1	2	3	4
Biological Monitoring	N/A	1	2	3	4
Time	N/A	1	2	3	4
Testing/Monitoring	N/A	1	2	3	4
Tests	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Test Control	N/A	1	2	3	4
Recording	N/A	1	2	3	4
Assembly and Preparation	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Wrapping Materials	N/A	1	2	3	4
Autoclave Tape	N/A	1	2	3	4
Dust Covers	N/A	1	2	3	4
Proper Towel/Linen Folding	N/A	1	2	3	4
Expiration Dates	N/A	1	2	3	4
Packing for Steam	N/A	1	2	3	4
Instrument Count Sheets	N/A	1	2	3	4
Placing Instruments on Trays	N/A	1	2	3	4