This skills assessment is designed to determine your level of competency in the areas listed below. By completing this checklist to the best of your ability, you will help us match your skills and areas of interest with our available assignments. Please indicate your appropriate level for each category as well as the date last performed.

Traveler Name:
Traveler Email:
Recruiter Name:
Date:

COMPETENCY LEVELSDATE LAST PERFORMED
1 = Functionally IndependentWithin 6 Months
2 = Some Experience6 mo. - 12 mo. ago
3 = Minor or No ExperienceOver 1 year ago
 Not Performed / Never Worked

SkillsCompetency LevelDate Last Performed
GENERAL DIAGNOSTIC
Abdomen Series
Chest
Extremities
IVP w/ & w/out Tomograms
Hip Series/Pelvis
Soft Tissue X-Rays
Gall Bladder
Pediatric Examinations
Facial Bones
Peripheral Dexascan
Bone Density
Portables
Skull Series
SPINE
1. Cervical
2. Thoracic
3. Lumber
FLUOROSCOPY
Small Bowel Series
UGI/Barium Swallow/Esophogram
UGI and small Bowel
Barium Enema with & without air
Esophogram
C- Arm- OR
Voiding Cystogram
Hysterosalpingogram
Arthrogram
SPECIAL PROCEDURES
Selective Angiography
ARTERIOGRAM
1. Carotid
2. Brachial
3. Arch
4. Renal
5. Mesenteric
6. Abdominal
CARDIAC CATH
Pulmonary Arteriogram
Atherectomy
Balloon Pumps
External Pacemakers
Internal Pacemakers
Coronary Angioplasty
IVC Filter
CT
Biopsy Procedures
SPINE
1. Cervical
2. Thoracic
3. Lumber
TM Joints (TMJ)
Internal Auditory Canals (IAC)
Brain
Abdomen
Pelvis
Pancreas
Orbits
Liver
Larnyx
Chest
MAMMOGRAPHY
Specialized Views
Needle localization
Specimen Radiographs
Digital Mammography
Screening Mammogram
Diagnostic Mammogram
Stereotatic Biopsy
QA
Ultrasound Assistance
MRI
T-1 Weighted Images/ computer setups
T-2 Weighted Images/ computer setups
Partial Saturation Images
Surface Coils - Radio Antenna
Gradient Echo Imaging
Multiplanar Reconstruction
Spin-Echo Images
MR Angiography
MRI Compatible Pressure Injectors
Echo Planar Imaging - EPI
Torso Array Coils
Cervical Spine
Lumbar Spine
Thoracic Spine
Brain
Shoulder
Hips
Pelvis
Knee
ULTRASOUND - ABDOMINAL
Pancreas
Liver
Gall bladder
Biliary Tract
Renals
Aorta/Great Vessels
Spleen
Cyst Aspirations
Biopsy Guidance
Pelvic
ULTRASOUND - OB/GYN
Uterus/Ovaries
Transvaginal Probe
Fetal Measurement for Age
Gest Sac Measurements for Age
Amniocentesis Guidance
ULTRASOUND - SMALL PARTS
Thyroid
Breasts
Prostate
Transrectal Probe
Scrotum
ULTRASOUND - SPECIALS
Neonatal Head
Venogram
Trans-esphageal
Trans Cranial Doppler
VASCULAR
Carotids
Venous for DVT
Venous Mapping
Arterial Pressures and Imaging
Color Flow
Popliteal
ECHOCARDIOGRAPHY
Real Time
Doppler
M-Mode
Color Flow
TTE and TEE
Contrast Agent Studies
Neonatal
Pediatric
Adult
Stress Test
Dobutamine Echo
NUCLEAR MEDICINE
Cerebral Blood Flow
GI Bleeding Study
Radionuclide Arteriogram
Radionuclide Venogram
I-131 Therapy
Thallium Stress - Test
SPECT Scanning
Thyroid Uptake Scan
Bone Scan, Blood Flow, Blood Pool Delay
Brain Scan
Gallium Scan
Liver-Spleen Scan
V,Q Lung Scan
Muga Scan
Renal Scan
Cardiolite Rest-Stress
Gastric Emptying
HiDA Scan
HiDA Scan with Kinevac
Parathyroid Scan
Indium-WBC Scan
Oncoscint Scan
Octreoscan
Please list any modality experience and the number of years of experience for each modality:
Please list any licenses or certifications held and when they expire:
Please list any area of competence (techniques, procedures, technologies, skills, etc.) where you would like to pursue additional training in order to enhance the level of care, treatment, or services to the population(s) that you serve:


Age Specific Competency

Please indicate the appropriate level for each category. When evaluating your competency level, please focus on the following guidelines:

Ability to ensure a safe and caring environment for the specific age groups indicated below.
Ability to communicate and instruct patients in the designated age groups.
Ability to evaluate age-appropriate behavior and skills.

Age GroupCompetency LevelDate Last Performed
Newborn (birth-30 days)
Infant (30 days-1 yrs)
Toddler (1-3 yrs)
Preschooler (3-5 yrs)
School Age (5-12 yrs)
Adolescents (12-18 yrs)
Young Adults (18-39 yrs)
Middle Adults (39-64 yrs)
Older Adults (64 yrs +)

To the best of my knowledge, the information represented above is an accurate reflection of my skills and abilities, and I authorize Soliant Health to share the above skills checklist with its clients.