Medical Physicist Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyAGE OF PATIENTS CARED FORNewborn/Neonate (birth to 30 days)(Required) 1 2 3 4 Infant (1 month to 1 year)(Required) 1 2 3 4 Toddler (1 year to 3 years)(Required) 1 2 3 4 Preschooler (3 years to 5 years)(Required) 1 2 3 4 School Age Child (5 years to 12 years)(Required) 1 2 3 4 Adolescents (12 years to 18 years)(Required) 1 2 3 4 Young Adults (18 years to 39 years)(Required) 1 2 3 4 Preschooler (3 years to 5 years)(Required) 1 2 3 4 Middle Adults (39 years to 64 years)(Required) 1 2 3 4 Older Adults (64+ years)(Required) 1 2 3 4 GENERAL SKILLSStandard Precautions(Required) 1 2 3 4 Isolation Precautions(Required) 1 2 3 4 Pediatric Respiratory/ Cardiac Arrest(Required) 1 2 3 4 Adult Respiratory/ Cardiac Arrest(Required) 1 2 3 4 Crash Carts(Required) 1 2 3 4 Defibrillators(Required) 1 2 3 4 BASIC CLINICAL SKILLS IN RADIOTHERAPYThe Clinical Environment(Required) 1 2 3 4 Simulation(Required) 1 2 3 4 Clinical Conduct(Required) 1 2 3 4 Chart Checking(Required) 1 2 3 4 Record and Verify Systems(Required) 1 2 3 4 Basic Radiation Safety(Required) 1 2 3 4 QUALITY ASSURANCE IN RADIATION ONCOLOGYLinear Accelerator Quality Assurance(Required) 1 2 3 4 Acceptance Testing and Commissioning(Required) 1 2 3 4 Measurement Equipment QA(Required) 1 2 3 4 CT Simulator QA(Required) 1 2 3 4 Portal Imaging and kV X-Ray Imaging QA(Required) 1 2 3 4 PET-CT QA(Required) 1 2 3 4 HDR QA(Required) 1 2 3 4 Prevention of Technology-Related Errors(Required) 1 2 3 4 TREATMENT PLANNINGPrerequisites for Treatment Planning(Required) 1 2 3 4 Mark and Start Cases(Required) 1 2 3 4 3D-Conformal Planning(Required) 1 2 3 4 IMRT Planning(Required) 1 2 3 4 Protocols(Required) 1 2 3 4 Secondary Monitor Unit (MU) Checks(Required) 1 2 3 4 Block Cutting(Required) 1 2 3 4 Diodes/TLD(Required) 1 2 3 4 Beam Data Collection, Modeling, and Commissioning(Required) 1 2 3 4 SPECIAL PROCEDURESRadiosurgery(Required) 1 2 3 4 LDR Brachytherapy(Required) 1 2 3 4 HDR Brachytherapy(Required) 1 2 3 4 TBI Electrons and Photons(Required) 1 2 3 4 IGRT Methods(Required) 1 2 3 4 Rotational Therapy(Required) 1 2 3 4 Proton Therapy(Required) 1 2 3 4 HEALTH PHYSICSRadiation Safety(Required) 1 2 3 4 Instrumentation for Health Physics Measurements(Required) 1 2 3 4 Shielding Calculations(Required) 1 2 3 4 Isotope Procedures(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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