Operating Room Nurse Skills Checklist
Please complete this checklist to assess your skills and competencies as an operating room nurse.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Years of Experience as an Operating Room Nurse
*
Highest Nursing Certification Achieved
*
Please Select
Registered Nurse (RN)
Certified Perioperative Nurse (CNOR)
Licensed Practical Nurse (LPN)
Other
Please rate your proficiency in the following core operating room skills:
*
Rows
No Experience
Basic
Competent
Proficient
Expert
Aseptic technique
1
2
3
4
5
Instrument identification and handling
6
7
8
9
10
Assisting with anesthesia
11
12
13
14
15
Patient positioning
16
17
18
19
20
Counting instruments and sponges
21
22
23
24
25
Operating room equipment setup
26
27
28
29
30
Specimen collection and labeling
31
32
33
34
35
Emergency response protocols
36
37
38
39
40
Are you familiar with the following surgical specialties? (Select all that apply)
General Surgery
Orthopedic Surgery
Cardiac Surgery
Neurosurgery
ENT Surgery
Other
Please list any additional certifications or specialized training (e.g., ACLS, PALS, Advanced Wound Care):
Rate your comfort level with electronic health record (EHR) systems used in the operating room.
*
1
2
3
4
5
Are you willing to participate in ongoing training and skill assessments?
*
Yes
No
Signature (Please sign to confirm the accuracy of your responses)
*
Submit Checklist
Submit Checklist
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