Certified Surgical First Assistant Skills Checklist

CERTIFIED SURGICAL FIRST ASSISTANT SKILLS CHECKLIST

One program to handle all talent management needs from acquisition to development

Personal Information

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Overall Score

Out of 4

Name(Required)

First Middle Last

Last 4 Digits of Social Security Number

Email(Required)

Hidden

Date

Key To Competency Levels

1 – No Experience
2 – Need Training
3 – Able to perform with supervision
4 –Able to perform independently

Miscellaneous

Adult Respiratory/ Cardiac Arrest(Required)

Autoclave(Required)

Automated Med Dispensing Systems(Required)

Care of Scopes & Fiberoptic Equipment(Required)

Cidex Soap(Required)

Crash Cart(Required)

Defibrillator(Required)

Electronic Documentation(Required)

Hand-off Communication(Required)

Isolation Precautions(Required)

Patient Identification(Required)

Pediatric Respiratory/ Cardiac Arrest(Required)

Standard Precautions(Required)

Universal Protocol(Required)

Experience With Ages

Newborn/Neonate (birth to 30 days)(Required)

Infant (1 month to 1 year)(Required)

Toddler (1 year to 3 years)(Required)

Preschooler (3 years to 5 years)(Required)

School Age Child (5 years to 12 years)(Required)

Adolescents (12 years to 18 years)(Required)

Young Adults (18 years to 39 years)(Required)

Middle Adults (39 years to 64 years)(Required)

Older Adults (64 years to 79 years)(Required)

Elderly Adults (over 79+ years)(Required)

General Surgery

Abdominal Perineal Resection(Required)

Adrenalectomy(Required)

Bowel Resection(Required)

Cholecystectomy(Required)

Colostomy/Ileostomy(Required)

Gastrectomy(Required)

Hemicolectomy(Required)

Hepatic Resection(Required)

Herniorrhaphy-Femoral/ Inguinal(Required)

Hiatal Herniorrhaphy- Transabdominal(Required)

Pancreatectomy(Required)

Organ Procurement(Required)

Radical Mastectomy(Required)

Saphenous Vein Ligation and Stripping(Required)

Splenectomy(Required)

Tracheostomy(Required)

Thyroidectomy(Required)

Whipple Procedure(Required)

Laparoscopic Procedures

Hysterectomy(Required)

Cholecystectomy(Required)

Appendectomy(Required)

Hernia Repair(Required)

Colon Resection(Required)

Gynecology

Caesarean Section(Required)

Dilation & Curettage(Required)

Hysterectomy-Vaginal(Required)

Hysterectomy-Abdominal(Required)

Laser Surgery(Required)

Radium Insertion(Required)

Salpingo- Oopherectomy(Required)

Shirodkar Procedure(Required)

Termination of Pregnancy(Required)

Tubal Ligation(Required)

Vaginectomy(Required)

Vaginal Reconstruction(Required)

G.U. and Cysto

Circumcision(Required)

Cystoscopy/ Cystostomy(Required)

Cystectomy(Required)

Hypospadius Repair(Required)

Ileal Loop(Required)

Lithotripsy(Required)

Nephrectomy(Required)

Orchiectomy(Required)

Penile Implant(Required)

Prostatectomy(Required)

Ureterolithotomy(Required)

Ureteroscopy(Required)

T.U.R.P./T.U.R.B(Required)

Vasectomy(Required)

Orthopedic

Amputation- Leg/ Arm(Required)

Application of Halo Traction(Required)

Arthroscopy/ Arthrotomy(Required)

Closed Pinning & Reduction of Extremities(Required)

External Compression Devices(Required)

Insertion of Finger Prosthesis(Required)

Total Joint Replacement- Knee, Hip, Shoulder(Required)

Spinal Fusion-Harrington Rods(Required)

Spica Cast Application(Required)

O.R.I.F.-Shoulder, Hip, Humerus, etc.(Required)

Repair of Dislocation(Required)

Patellectomy(Required)

Tendon Implants & Reanastomosis(Required)

Neurosurgery

Anterior Cervical Fusion(Required)

AV Malformation(Required)

Burrholes for Subdural Hematoma(Required)

Craniotomy(Required)

Discectomy/ Laminectomy(Required)

Laminectomy(Required)

Meningocele Repair(Required)

Nerve Stimulators(Required)

Shunt Procedures- VP/ VA(Required)

Spinal Procedures/ Fusions(Required)

Plastics

Abdominoplasty/Abdominal Lipectomy(Required)

Augmentation Mammoplasty(Required)

Breast Reduction/ Reconstruction(Required)

Cleft Lip/Palate Repair(Required)

Dermabrasion(Required)

Digital Flexor Tendon Repair(Required)

Face Lift(Required)

Liposuction(Required)

Otoplasty(Required)

Rhinoplasty(Required)

Reduction of Facial Fracture(Required)

Scar Revisions(Required)

Skin Grafting(Required)

Eye

Excision of Chalazion(Required)

Canthotomy(Required)

Correction of Ectropian/ Entropian(Required)

Corneal Transplant(Required)

Enucleation(Required)

I.O.I. Implants(Required)

Lacrimal Duct Probing(Required)

Refractive Keratoplasty(Required)

Repair of Retinal Detachment(Required)

Vitrectomy(Required)

Ear, Nose & Throat

Caldwell-Luc(Required)

Ethmoidectomy(Required)

Frontal Flap Sinus Procedure(Required)

Laryngectomy(Required)

Radical Neck(Required)

Septoplasty(Required)

Sinusotomy(Required)

Tonsillectomy & Adenoidectomy(Required)

Tracheostomy(Required)

Myringotomy(Required)

Mastoidectomy(Required)

Tympanoplasty(Required)

Stapedectomy(Required)

Nasal Polypectomy(Required)

Laryngoscopy(Required)

Endoscopy

Bronchoscopy(Required)

Cardiothoracic

Chest Tube Set- Up(Required)

Pneumonectomy/ Lobectomy(Required)

Septal Defect Repair(Required)

Sternal Splitting(Required)

Thoracotomy(Required)

Bronchoscopy(Required)

Lung/ Wedge Resection(Required)

Vein Harvesting(Required)

A-V Shunts(Required)

Aortic Aneurysm, Abdominal(Required)

Aortofemoral Bypass(Required)

Graft Insertion(Required)

Cardiac Valve Replacement(Required)

Coronary Artery Bypass Graft- on Pump(Required)

Endarterectomy- Carotid/ Femoral(Required)

Femoral- Popliteal Bypass(Required)

External Temporary Pacemaker(Required)

Internal Pacemaker Insertion(Required)

Intra-Aortic Balloon Pump Catheter(Required)

Patent Ductus Repair(Required)

Pericardial Windows(Required)

Portasystemic Shunt(Required)

Repair of Septal Defects(Required)

Thrombectomy(Required)

Vena Cava Ligation(Required)

Transplants

Bone Marrow(Required)

Pancreas(Required)

Heart(Required)

Lung(Required)

Liver(Required)

Multhorgan(Required)

Kidney(Required)

Eye(Required)

Trauma

Burns(Required)

MVA(Required)

Gun Shot Wounds(Required)

Stab Wounds(Required)

Equipment

Robotics(Required)

Fracture Tables(Required)

Video Systems(Required)

CUSA(Required)

Cell Saver(Required)

PACS Diagnostics(Required)

Electrocautery(Required)

Drills(Required)

Saws(Required)

Stapling Devices(Required)

Cardiac Monitors(Required)

Position Patient Per Surgeon's Order(Required)

Pressure Point Paddling(Required)

Apply Tourniquet as Ordered(Required)

Protect From Nerve Damage(Required)

Thermoregulation(Required)

Use of Fracture Table(Required)

Use of Head Stabilizer(Required)

Use of Body Stabilizer(Required)

Use of C-arm Extensions(Required)

Skin Assessment(Required)

Use of Retractors(Required)

Packing with Sponges(Required)

Digital Manipulation of Tissue(Required)

Suctioning, Irrigation, Sponging(Required)

Manipulation of Surgical Materials (Loops, Tags)(Required)

Clamping/Cauterizing Vessels or Tissues(Required)

Tying/Ligating Clamped Vessels or Tissues(Required)

Apply Hemostatic Clips(Required)

Direct Digital Pressure(Required)

Assist in Volume Replacement(Required)

Place Local Hemostatic Agents(Required)

Assist in Autotransfusion(Required)

Suturing: All Wound Layers Including Muscle & Fascia(Required)

Wound dressing: Liquid or Spray Occlusive(Required)

Absorbent Immobilizing Dressing(Required)

Assist to Secure Drainage System to Tissue(Required)

Insert/Remove Foley(Required)

Drape Patient(Required)

Electrocautery Mono(Required)

Electrocautery Bipolar(Required)

Cut Tissue(Required)

Harvest Saphenous Vein, Including Skin Incision(Required)

Dissect Common Femoral Artery and Bifurcate(Required)

Insert Drainage Tubes(Required)

Authorizations

Legal Consent(Required)

I agree to the terms and conditions.

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