Anesthesia Technician Skills Checklist Form
Anesthesia Technician Skills Checklist Form
Technician Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Experience Level
*
Entry Level
Intermediate
Advanced
Familiarity with Anesthesia Equipment
*
1
2
3
4
5
Preparation of Anesthesia Machines
*
1
2
3
4
5
Knowledge of Safety Protocols
*
1
2
3
4
5
Assistance During Anesthesia Procedures
*
1
2
3
4
5
Emergency Response Skills
*
1
2
3
4
5
Communication and Teamwork
*
1
2
3
4
5
Additional Comments (optional)
Submit
Should be Empty: