Nurses
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Medical / Surgical Telemetry Skills Checklist

Candidate Self Assessment

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Proficiency Scale & Legend

1 Theory – No Experience
2 Minimal Experience (0-12 Months)
3 Experienced/Competent (Greater than 12 Months)
4 Able to Teach/ Supervise

Skills - Medication Admini Stration

1
2
3
4

Respiratory

1
2
3
4

Sputum Collections

1
2
3
4

Car Diac

1
2
3
4

Neurology

1
2
3
4

Care Of The Patient With

1
2
3
4

Gastrointestinal

1
2
3
4

Care Of The Patient With

1
2
3
4

Renal

1
2
3
4

Care Of The Patient With

1
2
3
4

Vascular

1
2
3
4

Orthopedic

1
2
3
4

Gynecology

1
2
3
4

Other

1
2
3
4

Care Of The Patient With

1
2
3
4

Telemetry

1
2
3
4

Care Of Patient With

1
2
3
4

Respiratory

1
2
3
4

Vascular

1
2
3
4

Medications

1
2
3
4

Certification

  Expiration Date
BLS
ACLS
NRP
PALS
OTHER
OTHER 2

Licensure(s) Number(s)

Licensure(s) Number(s) State(s)

AREAS OF EXPERTISE

  Years Months
Management Duties
Charge Duties