Skills Checklist – MTMLT

Skills Checklist – MTMLT

• Name
  
  First
  
  Last
• Phone
• Email
  
• CERTIFICATIONS*
  

  	Yes	No
  ASCP MT/MLS
  ASCP MLT
  HEW
  AMT

• Other Certifications: (if applicable)
• BLOOD BANK*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Patient Identification Process
  ABO/Rh/Antibody Screen & ID
  Crossmatch- Immediate Spin/ IgG
  Antigen Typing
  Antibody Typing: Gel Method
  Antibody Typing: Tube Method
  Cold Agglutinins
  Rhogam Screening
  Coombs Test Direct
  Coombs Test Indirect
  Cord Blood Evaluation
  Thawing/ Cooling of Blood Products
  Donor Collection Procedures
  Issue Blood Product to Pt. Care Area
  Emergency Release
  Elutions
  Transfusion Reaction Workshop
  Irradiating Packed Cells
  Splitting a Baby Unit

• CHEMISTRY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Specimen Preparation
  Acetone Analysis
  Arterial Blood Gas
  B-12 Folates
  Cardiac Enzymes
  Chromatography- Gas
  Chromatography- Thin Layer
  Electropheresis
  Hormone/ Thyroid
  Immunoassay
  Osmolality
  Therapeutic Drug Monitoring
  Tumor Markers
  Analyzer Use/ Troubleshooting
  Review & Interpretation of QC

• HEMATOLOGY / COAGULATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Automated Instrument Use
  Differential Manual
  Sed Rate Manual
  Reticulocyte Count
  Fetal Hemoglobin
  RBC Morphology
  Platelet Count
  Sickle Cell Prep
  Platelet Morphology
  Body Fluid Manual Cell Count
  Body Fluid Manual diff.
  Special Stains- e.g. PAS, LAP, Peroxidase
  WBC Stool
  Semen Analysis
  PT/PTT/INR
  D-Dimer
  Fibrinogen
  Factor Assays
  Fibrin Degradation Products
  Thrombin Time
  Platelet Function Analysis

• IMMUNOLOGY / SEROLOGY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  RPR/ RPR Titer*
  Rheumatoid Titer*
  ANA
  LE Prep*
  HIV Rapid*
  HIV Antibody Detection*
  Rubella*
  CMV*

• MICROBIOLOGY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Plating Micro Specimens
  Reading Plates
  Gram Stains
  Kit Testing- Monospot/ ASO Titer
  Kit Testing- Flu/Rapid Strep/ RSV
  Wet Prep/ KOH Prep
  AFB Stain/ Culture
  O&P
  CDiff
  Occult Blood
  Chlamydia
  Processing Specimens for Viral/ Fungal Cultures

• URINALYSIS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Crystal Identification
  Macroscopic Analysis
  Microscopic Analysis
  Pregnancy Testing

• PHLEBOTOMY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Patient Identification
  PPE Equipment (Gloves, Mask, Etc.)*
  Adult Venipuncture*
  Pediatric Venipuncture*
  Dermal Stick (Finger/Heel)*
  Butterfly Draw*
  Arterial Draw*
  Tube Types and Usage*
  Centrifuge Operations*
  Bleeding Time*
  Blood Culture Collections*
  Blood Alcohol Collections*
  Drug Screening Collections*

• Equipment List

• LIS Systems*
• Chemistry*
• Hematology*
• Urinalysis*
• Coagulation*
• Blood Bank*
• Microbiology*
• Miscellaneous*

• Personal

• Age Group Experience*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Newborn (birth – 30 days)
  Infant (30 days – 1 year)
  Toddler (1 – 3 years)
  Preschooler (3 – 5 years)
  School Age (5 – 12 years)
  Adolescents (12 – 18 years)
  Young Adults (18 – 39 years)
  Middle Adults (39-64 years)
  Older Adults (64+ years)

• Do you speak any languages other than English?*
  • No

  If yes, enter languages above, separated by commas.

• Confirmation*
  • 
    I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
• Signature
• Date
  
  Date Format: MM slash DD slash YYYY