Ultrasound Tech Skills Checklist

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1 – 2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Full Name(Required)

Email(Required)

Send to(Required)

Date(Required)

AGE OF CLIENTS:

Newborn/Neonate (birth to 30 days)(Required)

Infant (31 days to 12 months)(Required)

Toddler/Preschool (13 months to 5 years)(Required)

School Age Child/adolescent (6 years to 18 years)(Required)

Young Adults Middle Adult (19 years to 64 years)(Required)

Older Adults/Elderly (65+years)(Required)

WORK SETTINGS

Adult(Required)

Pediatrics(Required)

Neonatal(Required)

Obstetrics(Required)

High Risk OB(Required)

Maternal / Fetal Medicine(Required)

GENERAL ULTRASOUND

Abdominal – Limited / Complete(Required)

Aorta(Required)

Appendix(Required)

Biliary Tract(Required)

Gall Bladder(Required)

Liver(Required)

Lung Biopsy(Required)

Pancreas(Required)

Paracentesis(Required)

Renal / Cyst Aspiration(Required)

Spleen(Required)

Pelvic Male(Required)

Intra-Operative(Required)

SMALL PARTS

Breast(Required)

Superficial Masses(Required)

Biopsies(Required)

Breast / Cyst Aspiration(Required)

Prostate / Transrectal ProbeEmbolism(Required)

Testicles(Required)

Thyroid(Required)

RENAL/PELVIS

Renal / Bladder(Required)

Renal Artery Doppler(Required)

Adnexa / Ovaries / Uterus(Required)

Hernia(Required)

Prostate(Required)

PELVIC TRANSABDOMINAL-FEMALE

Adnexa(Required)

Uterus(Required)

Endometrial Canal(Required)

Ovaries(Required)

Transvaginal(Required)

OBGYN/FIRST TRIMESTER

Adnexa(Required)

Amniotic Fluid (Abnormal)(Required)

Amniotic Fluid (Normal)(Required)

Crown Rump Length 6-14 Weeks(Required)

Fetal Demise(Required)

Left Ventricular Outflow Tract (LVOT(Required)

Right Ventricular Outflow Tract (RVOT)(Required)

Multiple Pregnancy(Required)

Spine if Visualized(Required)

Lower Uterine Segment(Required)

Nuchal Translucency(Required)

Placenta Previa(Required)

OBGYN/SECOND TRIMESTER

Cervical Shortening(Required)

Insert into Placenta & Abdomen(Required)

3-Vessel Cord / Ratio / Insertion(Required)

4-Chamber Heart (Abnormal)(Required)

4-Chamber Heart (Normal)(Required)

ABD / HC Ratio(Required)

Abdominal Circumference(Required)

Bladder(Required)

Cephalic Index(Required)

Cerebellum(Required)

Cerebral Ventricles(Required)

Cisterna Magna(Required)

Diaphragm(Required)

Feet(Required)

Gender(Required)

Femur Length(Required)

Hands(Required)

Intraorbital Measurements(Required)

Head Circumference(Required)

Kidneys(Required)

Interorbital Measurements(Required)

Nose & Lips(Required)

Placenta Location(Required)

Nuchal Fold(Required)

Stomach(Required)

OBGYN/THIRD TRIMESTER

Amniocentesis (If Applicable)(Required)

High Risk(Required)

Cyst Aspiration(Required)

Transvaginal Procedures(Required)

Biopsy Puncture(Required)

Aorta(Required)

Liver / Spleen(Required)

Renal Arteries(Required)

Legs / Venous(Required)

OPG Eye(Required)

Legs / Arterial(Required)

Segmental Pressures(Required)

Popliteal(Required)

Transcranial(Required)

EQUIPMENT

Acuson(Required)

Aspen(Required)

Cypress(Required)

Sequoia(Required)

128XP10(Required)

Philips / ATL(Required)

HDI 1000(Required)

HDI 3000(Required)

HDI 4000(Required)

HDI 5000(Required)

UM9 HDI(Required)

Philips HP(Required)

Sonos 1000(Required)

Sonos 2000 / 2500(Required)

Sonos 5500(Required)

Imagepoint(Required)

Imagepoint HX(Required)

GE(Required)

Logiq 500 PRO(Required)

Lifting / Transfer Devices(Required)

Logiq 7(Required)

Logiq 700(Required)

Logiq 500MD(Required)

Logiq 9(Required)

Vivid 7(Required)

Vivid 5(Required)

Voluson 730(Required)

Siemens(Required)

Elegra(Required)

Prima(Required)

Toshiba(Required)

SSH-140(Required)

PowerVision 8000(Required)

COMPUTER SYSTEMS

AGFA(Required)

Fuji(Required)

GE(Required)

Siemens(Required)

GENERAL SKILLS

Patients in Restraints(Required)

Lifting / Transfer Devices(Required)

Cardiac Arrest / CPR(Required)

Use of Rapid Response Teams(Required)

NATIONAL PATIENT SAFETY GOALS

Accurate Patient Identification(Required)

Effective Communication(Required)

Infection Control(Required)

Universal Precautions(Required)

Patients in Isolation(Required)

Minimize Risk for Fall(Required)

OTHER SKILLS

List here(Required)

Please rate your experience / frequency within the last year

AGE OF CLIENTS:

WORK SETTINGS

GENERAL ULTRASOUND

SMALL PARTS

RENAL/PELVIS

PELVIC TRANSABDOMINAL-FEMALE

OBGYN/FIRST TRIMESTER

OBGYN/SECOND TRIMESTER

OBGYN/THIRD TRIMESTER

EQUIPMENT

COMPUTER SYSTEMS

GENERAL SKILLS

NATIONAL PATIENT SAFETY GOALS

OTHER SKILLS

.

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