Imaging Skills Checklist

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Candidate Name

Email of Recruiter / POC

Select Submission Date

SSN (Last 4 digits)

Proficiency Scale & Legend

1 No Experience

2 Need Training

3 Able to perform with supervision

4 Able to perform independently

Ct Scanning

Abdomen

Biopsy procedures

Brain with contrast

Brain without contrast

Cervical spine

Chest

Cardiac echo imaging

IAC

Larynx

Liver

Lumbar spine

MR angiography

Orbits

Pancreas

Partial saturation image

Pelvis

Renal cyst puncture

Surface coils

Thoracic spine

TM joints

Ultrasound

Nuclear Medicine

Equipment

General Diagnostics

Radiation

Mri

Age Specific Competency

Able to ensure a safe and caring environment for the specific age groups indicated below; able to communicate and instruct patients from various age groups; able to evaluate age-appropriate behavior and skills.

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.