Nurses
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Operating Room Nurse Proficiency Skills Checklist

Candidate Self Assessment

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Proficiency Scale & Legend

1 Perform without assistance
2 Require some assistance
3 Require considerable assistance
4 No experience

General Surgery

1
2
3
4

Gynecology

1
2
3
4

G.u.

1
2
3
4

E.n.t.

1
2
3
4

Cardio-vascular

1
2
3
4

Orthopaedic

1
2
3
4

Neurosurgery

1
2
3
4

Plastics

1
2
3
4

Opthalmic

1
2
3
4

Thoracic

1
2
3
4

Endoscopy

1
2
3
4

Anaesthetics

1
2
3
4

Please indicate the number of years experience in each:

EXPERIENCE LEVELS =: C = Circulate / S = Scrub / B = Both / N = Neither

Experience Levels Value
Circulate
Scrub
Adult
Pediatric
Both

Personal Objections to

  Yes/No
Therapeutic Abortions
Salpingectomies

Additional Skills