800-299-8132

Call us today at 800-299-8132

Cirrus Medical Staffing

Call us today at 800-299-8132

Respiratory Therapy Skills Checklist

*Indicates Required Fields

Name   
*
SSN (last 4 only)   
Phone   
EMail   
*
I want a copy on email   

KEY
Proficiency   :    [1] None   [2] Intermittent   [3] Experienced   [4] Supervise / Teach  
Frequency    :    [1] Never / Observation only   [2] Less Than 6 Months   [3] Twice / Month   [4] Daily - Weekly  


Adult/Geriatric

Proficiency

Frequency
Assessment/Patient Care
Adult/ICU/Trauma
Burns 1 2 3 4 1 2 3 4
Trauma & Emergency 1 2 3 4 1 2 3 4
Smoke Inhalation & Burns 1 2 3 4 1 2 3 4
Chest Physical Therapy 1 2 3 4 1 2 3 4
Chest Trauma 1 2 3 4 1 2 3 4
Chronic Obstructive Pulm. Disease 1 2 3 4 1 2 3 4
Neurological Disorders 1 2 3 4 1 2 3 4
Restrictive Pulmonary Diseases 1 2 3 4 1 2 3 4
Routine Therapy & Treatment 1 2 3 4 1 2 3 4
Smoke Inhalation & Burns 1 2 3 4 1 2 3 4
Neonatal/Pediatric
Chest Physical Therapy 1 2 3 4 1 2 3 4
Chest Trauma 1 2 3 4 1 2 3 4
Croup 1 2 3 4 1 2 3 4
Cystic Fibrosis 1 2 3 4 1 2 3 4
Epiglottitis 1 2 3 4 1 2 3 4
Infant Resp Distress Syndrome 1 2 3 4 1 2 3 4
Meconium Aspiration 1 2 3 4 1 2 3 4
Neurological Disorders 1 2 3 4 1 2 3 4
Persistent Fetal Circulation 1 2 3 4 1 2 3 4
Pneumothorax 1 2 3 4 1 2 3 4
Respiratory Syncytial Virus 1 2 3 4 1 2 3 4
Restrictive Pulmonary Diseases 1 2 3 4 1 2 3 4
Routine Therapy & Treatment 1 2 3 4 1 2 3 4
Smoke Inhalation & Burns 1 2 3 4 1 2 3 4
Trauma 1 2 3 4 1 2 3 4
Airway Management
Oral Pharyngeal Airways 1 2 3 4 1 2 3 4
Nasal Pharyngeal Airways 1 2 3 4 1 2 3 4
Endotracheal Tubes 1 2 3 4 1 2 3 4
Tracheostomy Tubes 1 2 3 4 1 2 3 4
Basic Diagnostic Monitoring
Pulse Oximetry 1 2 3 4 1 2 3 4
End-tidal Carbon Dioxide Monitoring 1 2 3 4 1 2 3 4
Weaning Parameters 1 2 3 4 1 2 3 4
Peak Expiratory Flow Rates 1 2 3 4 1 2 3 4
Bedside Spirometry-Pulmonary Screening 1 2 3 4 1 2 3 4
Patient Assessment 1 2 3 4 1 2 3 4
Auscultation/Palpation 1 2 3 4 1 2 3 4
Non-Invasive Cardiac Output Monitoring 1 2 3 4 1 2 3 4
ABG Interpretation 1 2 3 4 1 2 3 4
Transcutaneous Monitoring 1 2 3 4 1 2 3 4
Radiograph Interpretation 1 2 3 4 1 2 3 4
Computerized Documentation 1 2 3 4 1 2 3 4
Medication/Therapeutic Interventions
Basic Respiratory Treatments
Chest Physiotherapy 1 2 3 4 1 2 3 4
DPI (Advair/Spiriva) 1 2 3 4 1 2 3 4
Hand-Held Nebulizer 1 2 3 4 1 2 3 4
Incentive Spirometry 1 2 3 4 1 2 3 4
Intermittent Positive Pressure Breathing 1 2 3 4 1 2 3 4
Metered Dose Inhaler 1 2 3 4 1 2 3 4
Postural Drainage - Percussion/Vibration 1 2 3 4 1 2 3 4
Ultrasonic Nebulization 1 2 3 4 1 2 3 4
Advanced Respiratory Treatments
PEP Devices Flutter Valve, Etc 1 2 3 4 1 2 3 4
Inspiratory/Expiratory Muscle Training 1 2 3 4 1 2 3 4
Vest Therapy Chest Wall Oscillation 1 2 3 4 1 2 3 4
Heli-Ox Therapy 1 2 3 4 1 2 3 4
Continuous Medication Nebulizer 1 2 3 4 1 2 3 4
Small Particle Aerosol Generator 1 2 3 4 1 2 3 4
Therapeutic Bronchoscope 1 2 3 4 1 2 3 4
Bi-Level Positive Airway Pressure 1 2 3 4 1 2 3 4
Continuous Positive Airway Pressure 1 2 3 4 1 2 3 4
PHARMACOLOGICAL INTERVENTION
Bronchodilators 1 2 3 4 1 2 3 4
Steroids 1 2 3 4 1 2 3 4
Anti-Invectives 1 2 3 4 1 2 3 4
Mucolytics 1 2 3 4 1 2 3 4
Paralytics 1 2 3 4 1 2 3 4
Aerosol and Gas Therapy
Oxygen Therapy 1 2 3 4 1 2 3 4
Small Volume Nebulizer 1 2 3 4 1 2 3 4
Oxygen Administration
Bag Mask and Valve 1 2 3 4 1 2 3 4
Concentrator 1 2 3 4 1 2 3 4
Continuous Aerosol 1 2 3 4 1 2 3 4
Face Tent 1 2 3 4 1 2 3 4
Liquid Oxygen 1 2 3 4 1 2 3 4
Nasal Cannula 1 2 3 4 1 2 3 4
Oxygen Hood 1 2 3 4 1 2 3 4
Oxygen Masks 1 2 3 4 1 2 3 4
Oxygen Tent 1 2 3 4 1 2 3 4
Trach Collor 1 2 3 4 1 2 3 4
Venturi Mask 1 2 3 4 1 2 3 4
Procedures/Equipment
Airway
Endotracheal Intubation 1 2 3 4 1 2 3 4
Tracheostomy Re-Insertion 1 2 3 4 1 2 3 4
Oropharyngeal Tube Insertion 1 2 3 4 1 2 3 4
Bronchopulmonary Hygiene
Chest Physiotherapy 1 2 3 4 1 2 3 4
IPPB 1 2 3 4 1 2 3 4
Thera-Vest 1 2 3 4 1 2 3 4
Oral and Nasal Suctioning 1 2 3 4 1 2 3 4
CPAP and BIPAP
Nasal Mask 1 2 3 4 1 2 3 4
Nasal Pillow 1 2 3 4 1 2 3 4
Full Face Mask 1 2 3 4 1 2 3 4
Vision 1 2 3 4 1 2 3 4
Knight Star 1 2 3 4 1 2 3 4
VPAP 1 2 3 4 1 2 3 4
Respironics 1 2 3 4 1 2 3 4
Nellcor 1 2 3 4 1 2 3 4
Resmed 1 2 3 4 1 2 3 4
Ventilator Management
Adult Ventilator
Puritan Bennett 7200 1 2 3 4 1 2 3 4
Puritan Bennett 840 1 2 3 4 1 2 3 4
Siemens Servo 900 C 1 2 3 4 1 2 3 4
Siemens Servo SV 300 (A) 1 2 3 4 1 2 3 4
Siemens Servo 1 2 3 4 1 2 3 4
Dragger 1 2 3 4 1 2 3 4
Hamilton 1 2 3 4 1 2 3 4
Adult Star 1 2 3 4 1 2 3 4
LTV-1000 1 2 3 4 1 2 3 4
LP-10 1 2 3 4 1 2 3 4
Respironics Ventilators 1 2 3 4 1 2 3 4
Infant Ventilators
Bear Cub 1 2 3 4 1 2 3 4
Infant Start 1 2 3 4 1 2 3 4
Sea Christ 1 2 3 4 1 2 3 4
BP-200 1 2 3 4 1 2 3 4
Adult High Frequency Ventilation 1 2 3 4 1 2 3 4
Adult Ventilator Management 1 2 3 4 1 2 3 4
Infant Ventilator Management 1 2 3 4 1 2 3 4
Neonatal High Freq. Ventilation 1 2 3 4 1 2 3 4
Neonatal Ventilator Management 1 2 3 4 1 2 3 4
Pediatric Ventilator Management 1 2 3 4 1 2 3 4
Pressure Controlled Ventilators 1 2 3 4 1 2 3 4
Time Cycled Ventilators 1 2 3 4 1 2 3 4
Vent. Management via Parameters 1 2 3 4 1 2 3 4
Volume Controlled Ventilators 1 2 3 4 1 2 3 4
Procedures
12 Lead EKG 1 2 3 4 1 2 3 4
Arterial Blood Gas Sampling 1 2 3 4 1 2 3 4
Arterial Line Insertion 1 2 3 4 1 2 3 4
Arterial Line Maintenance 1 2 3 4 1 2 3 4
Bedside Pulm. Function Testing 1 2 3 4 1 2 3 4
Bronchoscope Assistance 1 2 3 4 1 2 3 4
Capnography 1 2 3 4 1 2 3 4
Cardiac Stress Testing 1 2 3 4 1 2 3 4
Cardiograms 1 2 3 4 1 2 3 4
Complete Pulm. Function Testing 1 2 3 4 1 2 3 4
Diffusion Studies 1 2 3 4 1 2 3 4
DLCO 1 2 3 4 1 2 3 4
ECMO Assistance 1 2 3 4 1 2 3 4
ECMO Operation 1 2 3 4 1 2 3 4
Electrocardiograms 1 2 3 4 1 2 3 4
Hemodynamic Monitoring 1 2 3 4 1 2 3 4
Hyperbaric Therapy 1 2 3 4 1 2 3 4
Intubation Assistance 1 2 3 4 1 2 3 4
Lung Volume Studies 1 2 3 4 1 2 3 4
Phlebotomy 1 2 3 4 1 2 3 4
Pulmonary Exercise Testing 1 2 3 4 1 2 3 4
Pulmonary Function Testing 1 2 3 4 1 2 3 4
Sleep Apnea Studies 1 2 3 4 1 2 3 4
Thermal Dilution Cardiac Output 1 2 3 4 1 2 3 4
Transcutaneous Monitoring 1 2 3 4 1 2 3 4
Age Group Experience
Age Groups
0 - 30 Days 1 2 3 4 1 2 3 4
30 Days - 1 Year 1 2 3 4 1 2 3 4
1 - 3 Years 1 2 3 4 1 2 3 4
3 - 5 Years 1 2 3 4 1 2 3 4
5 - 12 Years 1 2 3 4 1 2 3 4
12 - 18 Years 1 2 3 4 1 2 3 4
18 - 39 Years 1 2 3 4 1 2 3 4
39 - 64 Years 1 2 3 4 1 2 3 4
64+ Years 1 2 3 4 1 2 3 4
Clinical Settings
Acute Care 1 2 3 4 1 2 3 4
Adult ICU 1 2 3 4 1 2 3 4
Pedi ICU 1 2 3 4 1 2 3 4
NICU 1 2 3 4 1 2 3 4
ER 1 2 3 4 1 2 3 4
Trauma Level 1 1 2 3 4 1 2 3 4
Trauma Level 2 1 2 3 4 1 2 3 4
Trauma Level 3 1 2 3 4 1 2 3 4
SNT 1 2 3 4 1 2 3 4
LTC 1 2 3 4 1 2 3 4
Home Health 1 2 3 4 1 2 3 4
Sleep Lab 1 2 3 4 1 2 3 4
LTAC 1 2 3 4 1 2 3 4
Credentials
Advanced Cardiopulmonary Life Support (ACLS) 1 2 3 4 1 2 3 4
Basic Cardiopulmonary Life Support (BCLS) 1 2 3 4 1 2 3 4
Certified Asthma Educator 1 2 3 4 1 2 3 4
Certified EKG Technician 1 2 3 4 1 2 3 4
Certified Eligible 1 2 3 4 1 2 3 4
Certified Pulmonary Function Technologist 1 2 3 4 1 2 3 4
Certified Respiratory Therapy Technician 1 2 3 4 1 2 3 4
Licensed Respiratory Care Practitioner 1 2 3 4 1 2 3 4
Neonatal Advanced Life Support (NALS) 1 2 3 4 1 2 3 4
Pediatric Advanced Life Support (PALS) 1 2 3 4 1 2 3 4
Perinatal/Pediatric Specialist 1 2 3 4 1 2 3 4
Registered Pulmonary Function Technologist 1 2 3 4 1 2 3 4
Registered Respiratory Therapist 1 2 3 4 1 2 3 4
Registered Sleep Technician 1 2 3 4 1 2 3 4
Registry Eligible 1 2 3 4 1 2 3 4

By affixing the last 4 digit of the SSN, I certify that I have electronically completed this skills checklist on the date shown below.
Last 4 digit of SSN   Date