Nightingale Nursing: Travel Nursing Jobs, Travel Nurse Jobs, Travel Nurse Staffing

	Want a better nursing job? Call us: 800-735-6170
*The Most Trusted RN Travel Nurse Staffing Service*

Operating Room 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

General Surgery: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Appendectomy	N/A	1	2	3	4
Breast Biopsy	N/A	1	2	3	4
Cholecystectomy	N/A	1	2	3	4
Abdominal-Perineal Resection	N/A	1	2	3	4
Bowel/Colon Resection	N/A	1	2	3	4
Hernia Repair	N/A	1	2	3	4
Thyroidectomy	N/A	1	2	3	4
Splenectomy	N/A	1	2	3	4
Vein Stripping	N/A	1	2	3	4
Radical Mastectomy	N/A	1	2	3	4
Tracheostomy	N/A	1	2	3	4
Gastrectomy	N/A	1	2	3	4
Hickman/Groshong/Portacath Insertion	N/A	1	2	3	4
Cholecystectomy	N/A	1	2	3	4
Hernia Repair	N/A	1	2	3	4
Bowel	N/A	1	2	3	4
Nissen	N/A	1	2	3	4
Bariatric	N/A	1	2	3	4
General Surgery: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Appendectomy	N/A	1	2	3	4
Breast Biopsy	N/A	1	2	3	4
Cholecystectomy	N/A	1	2	3	4
Abdominal-Perineal Resection	N/A	1	2	3	4
Bowel/Colon Resection	N/A	1	2	3	4
Hernia Repair	N/A	1	2	3	4
Thyroidectomy	N/A	1	2	3	4
Splenectomy	N/A	1	2	3	4
Vein Stripping	N/A	1	2	3	4
Radical Mastectomy	N/A	1	2	3	4
Tracheostomy	N/A	1	2	3	4
Gastrectomy	N/A	1	2	3	4
Hickman/Groshong/Portacath Insertion	N/A	1	2	3	4
Cholecystectomy	N/A	1	2	3	4
Hernia Repair	N/A	1	2	3	4
Bowel	N/A	1	2	3	4
Nissen	N/A	1	2	3	4
Bariatric	N/A	1	2	3	4
Thoracic/CV: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Abdominal Aortic Aneurysm	N/A	1	2	3	4
Aortic-Femoral Bypass Graft	N/A	1	2	3	4
AV Shunt/Graft	N/A	1	2	3	4
Carotid Endarterectomy	N/A	1	2	3	4
Lobectomy	N/A	1	2	3	4
Mediastinoscopy	N/A	1	2	3	4
Thoracoscopy	N/A	1	2	3	4
Thoracotomy	N/A	1	2	3	4
Thoracic/CV: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Abdominal Aortic Aneurysm	N/A	1	2	3	4
Aortic-Femoral Bypass Graft	N/A	1	2	3	4
AV Shunt/Graft	N/A	1	2	3	4
Carotid Endarterectomy	N/A	1	2	3	4
Lobectomy	N/A	1	2	3	4
Mediastinoscopy	N/A	1	2	3	4
Thoracoscopy	N/A	1	2	3	4
Thoracotomy	N/A	1	2	3	4
Orthopedic/Podiatry: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Knee Arthroscopy	N/A	1	2	3	4
ACL Repair	N/A	1	2	3	4
Shoulder Arthroscopy	N/A	1	2	3	4
Endoscopic Shoulder Repair	N/A	1	2	3	4
Open Shoulder Repair	N/A	1	2	3	4
Total Knee Replacement/Revision	N/A	1	2	3	4
Total Hip Replacement/Revision	N/A	1	2	3	4
Bipolar Hip Replacement	N/A	1	2	3	4
Hip Compression Nails and Lag Screw	N/A	1	2	3	4
Hand Surgery	N/A	1	2	3	4
External Fixation Devices	N/A	1	2	3	4
IM Roddings	N/A	1	2	3	4
Bunionectomy	N/A	1	2	3	4
Spinal Fusion With Instrumentation	N/A	1	2	3	4
Harrington Rod Insertion	N/A	1	2	3	4
Carpal Tunnel Repair	N/A	1	2	3	4
Chick Fracture Table	N/A	1	2	3	4
ORIF With Compression Set	N/A	1	2	3	4
Closed Reduction Fracture	N/A	1	2	3	4
Orthopedic/Podiatry: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Knee Arthroscopy	N/A	1	2	3	4
ACL Repair	N/A	1	2	3	4
Shoulder Arthroscopy	N/A	1	2	3	4
Endoscopic Shoulder Repair	N/A	1	2	3	4
Open Shoulder Repair	N/A	1	2	3	4
Total Knee Replacement/Revision	N/A	1	2	3	4
Total Hip Replacement/Revision	N/A	1	2	3	4
Bipolar Hip Replacement	N/A	1	2	3	4
Hip Compression Nails and Lag Screw	N/A	1	2	3	4
Hand Surgery	N/A	1	2	3	4
External Fixation Devices	N/A	1	2	3	4
IM Roddings	N/A	1	2	3	4
Bunionectomy	N/A	1	2	3	4
Spinal Fusion With Instrumentation	N/A	1	2	3	4
Harrington Rod Insertion	N/A	1	2	3	4
Carpal Tunnel Repair	N/A	1	2	3	4
Chick Fracture Table	N/A	1	2	3	4
ORIF With Compression Set	N/A	1	2	3	4
Closed Reduction Fracture	N/A	1	2	3	4
Neurosurgery: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cervical Laminectomy (Anterior)	N/A	1	2	3	4
Cervical Laminectomy (Posterior)	N/A	1	2	3	4
Lumbar Laminectomy	N/A	1	2	3	4
VP Shunt (Ventricualr-Peitoneal)	N/A	1	2	3	4
Craniotomy	N/A	1	2	3	4
Burr Holes (Sub-Dural Hematoma)	N/A	1	2	3	4
Neurosurgery: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cervical Laminectomy (Anterior)	N/A	1	2	3	4
Cervical Laminectomy (Posterior)	N/A	1	2	3	4
Lumbar Laminectomy	N/A	1	2	3	4
VP Shunt (Ventricualr-Peitoneal)	N/A	1	2	3	4
Craniotomy	N/A	1	2	3	4
Burr Holes (Sub-Dural Hematoma)	N/A	1	2	3	4
Plastic/Reconstructive Surgery: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Abdominoplasty	N/A	1	2	3	4
Facelift	N/A	1	2	3	4
Skin Grafts	N/A	1	2	3	4
Breast Reconstruction	N/A	1	2	3	4
Breast Augmentation	N/A	1	2	3	4
Breast Reduction	N/A	1	2	3	4
Rhinoplasty	N/A	1	2	3	4
Cleft Palate Repair	N/A	1	2	3	4
Liposuction	N/A	1	2	3	4
Blepharoplasty	N/A	1	2	3	4
Tissue Expanders	N/A	1	2	3	4
Plastic/Reconstructive Surgery: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Abdominoplasty	N/A	1	2	3	4
Facelift	N/A	1	2	3	4
Skin Grafts	N/A	1	2	3	4
Breast Reconstruction	N/A	1	2	3	4
Breast Augmentation	N/A	1	2	3	4
Breast Reduction	N/A	1	2	3	4
Rhinoplasty	N/A	1	2	3	4
Cleft Palate Repair	N/A	1	2	3	4
Liposuction	N/A	1	2	3	4
Blepharoplasty	N/A	1	2	3	4
Tissue Expanders	N/A	1	2	3	4
Opthalmology: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cataract Extraction with IOL	N/A	1	2	3	4
Corneal Transplant	N/A	1	2	3	4
Dacryocystectomy	N/A	1	2	3	4
Phaco Emulsification	N/A	1	2	3	4
Orbital Implant	N/A	1	2	3	4
Enucleation	N/A	1	2	3	4
Vitrectomy	N/A	1	2	3	4
Scleral Buckle	N/A	1	2	3	4
Muscle Procedures	N/A	1	2	3	4
Opthalmology: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cataract Extraction with IOL	N/A	1	2	3	4
Corneal Transplant	N/A	1	2	3	4
Dacryocystectomy	N/A	1	2	3	4
Phaco Emulsification	N/A	1	2	3	4
Orbital Implant	N/A	1	2	3	4
Enucleation	N/A	1	2	3	4
Vitrectomy	N/A	1	2	3	4
Scleral Buckle	N/A	1	2	3	4
Muscle Procedures	N/A	1	2	3	4
ENT/Oral Surgery: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Bronchoscopy	N/A	1	2	3	4
T&A	N/A	1	2	3	4
Myringotomy	N/A	1	2	3	4
Stapedectomy	N/A	1	2	3	4
Tympanoplasty	N/A	1	2	3	4
Sinus Endoscopy	N/A	1	2	3	4
Septoplasty	N/A	1	2	3	4
Parotidectomy	N/A	1	2	3	4
TMJ	N/A	1	2	3	4
Jaw Fractures	N/A	1	2	3	4
Mini AO Compression	N/A	1	2	3	4
ENT/Oral Surgery: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Bronchoscopy	N/A	1	2	3	4
T&A	N/A	1	2	3	4
Myringotomy	N/A	1	2	3	4
Stapedectomy	N/A	1	2	3	4
Tympanoplasty	N/A	1	2	3	4
Sinus Endoscopy	N/A	1	2	3	4
Septoplasty	N/A	1	2	3	4
Parotidectomy	N/A	1	2	3	4
TMJ	N/A	1	2	3	4
Jaw Fractures	N/A	1	2	3	4
Mini AO Compression	N/A	1	2	3	4
Urology and Cysto: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Nephrectomy	N/A	1	2	3	4
Prostatectomy	N/A	1	2	3	4
Vasectomy	N/A	1	2	3	4
Cystectomy	N/A	1	2	3	4
Penile Prosthesis	N/A	1	2	3	4
TURP	N/A	1	2	3	4
Cystoscopy/Ureteroscopy	N/A	1	2	3	4
Lithotripsy	N/A	1	2	3	4
Hypospadias Repair	N/A	1	2	3	4
Orchiopexy	N/A	1	2	3	4
Urology and Cysto: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Nephrectomy	N/A	1	2	3	4
Prostatectomy	N/A	1	2	3	4
Vasectomy	N/A	1	2	3	4
Cystectomy	N/A	1	2	3	4
Penile Prosthesis	N/A	1	2	3	4
TURP	N/A	1	2	3	4
Cystoscopy/Ureteroscopy	N/A	1	2	3	4
Lithotripsy	N/A	1	2	3	4
Hypospadias Repair	N/A	1	2	3	4
Orchiopexy	N/A	1	2	3	4
GYN Surgery: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
AP Repair (Anterior and Posterior)	N/A	1	2	3	4
D&C	N/A	1	2	3	4
LEEP (Loop Electrode Excision Repair)	N/A	1	2	3	4
Abdominal Hysterectomy	N/A	1	2	3	4
Vaginal Hysterectomy	N/A	1	2	3	4
Laparoscopy	N/A	1	2	3	4
Laparoscopic Tubal Ligation	N/A	1	2	3	4
Laser Vaporization Condyloma	N/A	1	2	3	4
MMK (Marshall Marchetti Krantz)	N/A	1	2	3	4
Tubal Ligation	N/A	1	2	3	4
Hysteroscopy	N/A	1	2	3	4
GYN Surgery: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
AP Repair (Anterior and Posterior)	N/A	1	2	3	4
D&C	N/A	1	2	3	4
LEEP (Loop Electrode Excision Repair)	N/A	1	2	3	4
Abdominal Hysterectomy	N/A	1	2	3	4
Vaginal Hysterectomy	N/A	1	2	3	4
Laparoscopy	N/A	1	2	3	4
Laparoscopic Tubal Ligation	N/A	1	2	3	4
Laser Vaporization Condyloma	N/A	1	2	3	4
MMK (Marshall Marchetti Krantz)	N/A	1	2	3	4
Tubal Ligation	N/A	1	2	3	4
Hysteroscopy	N/A	1	2	3	4
Pediatrics: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Exploratory Laparotomy	N/A	1	2	3	4
Otoplasty	N/A	1	2	3	4
Circumcision	N/A	1	2	3	4
Hypospadias Repair	N/A	1	2	3	4
Herniorrhaphy	N/A	1	2	3	4
Cleft lip/Palate	N/A	1	2	3	4
Pediatrics: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Exploratory Laparotomy	N/A	1	2	3	4
Otoplasty	N/A	1	2	3	4
Circumcision	N/A	1	2	3	4
Hypospadias Repair	N/A	1	2	3	4
Herniorrhaphy	N/A	1	2	3	4
Cleft lip/Palate	N/A	1	2	3	4
Open Heart Surgery: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
CABG	N/A	1	2	3	4
ASD(Atrial Septal Defect)	N/A	1	2	3	4
VSD (Ventral Septal Defect)	N/A	1	2	3	4
Mitral or Aortic Valve Replacement	N/A	1	2	3	4
Tetrology of Fallot	N/A	1	2	3	4
Emergent Bring Back Heart	N/A	1	2	3	4
Open Heart Surgery: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
CABG	N/A	1	2	3	4
ASD(Atrial Septal Defect)	N/A	1	2	3	4
VSD (Ventral Septal Defect)	N/A	1	2	3	4
Mitral or Aortic Valve Replacement	N/A	1	2	3	4
Tetrology of Fallot	N/A	1	2	3	4
Emergent Bring Back Heart	N/A	1	2	3	4
Transplants: Circulate	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Kidney Transplant Recipient	N/A	1	2	3	4
Kidney Transplant Donor	N/A	1	2	3	4
Heart Transplant	N/A	1	2	3	4
Liver Transplant	N/A	1	2	3	4
Lung Transplant	N/A	1	2	3	4
Multi-Organ (Harvest)	N/A	1	2	3	4
Transplants: Scrub	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Kidney Transplant Recipient	N/A	1	2	3	4
Kidney Transplant Donor	N/A	1	2	3	4
Heart Transplant	N/A	1	2	3	4
Liver Transplant	N/A	1	2	3	4
Lung Transplant	N/A	1	2	3	4
Multi-Organ (Harvest)	N/A	1	2	3	4