Skills Checklist Certified Registered Nurse Anesthetist (CRNA) Self-Assessment "*" indicates required fields LinkedInThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formFirst NameThis field is hidden when viewing the formLast NameThis field is hidden when viewing the formEmail* This field is hidden when viewing the formToday's Date* MM slash DD slash YYYY InstructionsWhen completing this checklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark (x) in box which best describes your expertise with each skill. The scale is as follows: 1. Not performed 2. Intermittent experience 3. Very experienced. Under Procedures Performed below, place a check mark (x) in box which best describes your expertise with each skill in the right columns. In the left column indicate the number (#) of procedures performed in the last 24 months. Example (1, 2 or 3).SKILLS EXPERTISEAdults 1 2 3 Pediatrics 1 2 3 Neonatal 1 2 3 Cardiac 1 2 3 Orthopedic 1 2 3 Neurosurgical 1 2 3 Obstetrical 1 2 3 PROCEDURES PERFORMEDGeneral Anesthesia #General Anesthesia 1 2 3 Regional Anesthesia #Regional Anesthesia 1 2 3 Pre- Anesthesia Evaluation and Preparation #Pre- Anesthesia Evaluation and Preparation 1 2 3 Tracheal Intubation/Extubation #Tracheal Intubation/Extubation 1 2 3 Placement of Central Venous Catheters #Placement of Central Venous Catheters 1 2 3 Advanced Airway Management #Advanced Airway Management 1 2 3 Mechanical Ventilation/ Airway Management #Mechanical Ventilation/ Airway Management 1 2 3 Post anesthesia care/Discharge #Post anesthesia care/Discharge 1 2 3 Management of Respiratory/Ventilator Care #Management of Respiratory/Ventilator Care 1 2 3 Consent I certify that all the above information is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency. I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.
