Sleep Tech Skills Checklist Personal InformationName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) Date MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyGeneral SkillsStandard Precautions 1 2 3 4 Isolation Precautions 1 2 3 4 Pediatric Respiratory/Cardiac Arrest 1 2 3 4 Adult Respiratory/Cardiac Arrest 1 2 3 4 Crash Carts 1 2 3 4 Defibrillators 1 2 3 4 Electronic Documentation 1 2 3 4 Automated Med Dispensing Systems 1 2 3 4 SettingHospital 1 2 3 4 Independent Lab 1 2 3 4 Patient Home 1 2 3 4 Diagnostic Studies/ProceduresMultiple Sleep Latency Test (MSLT) 1 2 3 4 Maintenance of Wakefulness Test (MWT) 1 2 3 4 Nocturnal Penile Tumescence 1 2 3 4 Seizure Study 1 2 3 4 Portable Sleep Study 1 2 3 4 Split-Night Polysomnogram 1 2 3 4 EKG Electrode Placement 1 2 3 4 EEG Electrode Placement 1 2 3 4 Seizure Hook-Up 1 2 3 4 Calibration 1 2 3 4 Patient Positioning/Preparation 1 2 3 4 Drawing Arterial Blood Gases (ABGs) 1 2 3 4 Monitoring/ScoringPeriodic Limb Movements 1 2 3 4 Snores 1 2 3 4 Respiratory Events 1 2 3 4 Respiratory Disturbance Index (RDI) 1 2 3 4 Apnea-Hypopnea Index (AHI) 1 2 3 4 Periodic Breathing 1 2 3 4 Complex Sleep Apnea 1 2 3 4 Cheyne-Stokes 1 2 3 4 Obstructive Sleep Apnea 1 2 3 4 Hypopnea 1 2 3 4 Sleep Log 1 2 3 4 Seizure Recognition and Precaution 1 2 3 4 Transient Arousal Scoring Rules/Procedures 1 2 3 4 Equipment UsageOximeters 1 2 3 4 Nasal Cannula 1 2 3 4 Humidified O2 1 2 3 4 Nasal Mask 1 2 3 4 BiPAP 1 2 3 4 CPAP 1 2 3 4 Portable Set-Up 1 2 3 4 Position Sensor 1 2 3 4 Actimeter 1 2 3 4 Thermistor 1 2 3 4 Phillips Respironics 1 2 3 4 Nihon Kohden 1 2 3 4 Grass Technologies 1 2 3 4 Natus 1 2 3 4 ResMed 1 2 3 4 CleveMed 1 2 3 4 CareFusion BD 1 2 3 4 Compumedics 1 2 3 4 Cadwell 1 2 3 4 Somnomedics 1 2 3 4 Other EquipmentCredentialsCPSGT 1 2 3 4 RST 1 2 3 4 RPSGT 1 2 3 4 SDS 1 2 3 4 Age Specific CompetenciesNewborn/Neonate (Birth to 30 days) 1 2 3 4 Infant (30 days - 1 year) 1 2 3 4 Toddler (ages 1-3 years) 1 2 3 4 Preschooler (ages 3-5 years) 1 2 3 4 School age (ages 5-12 years) 1 2 3 4 Adolescents (ages 13-21 years) 1 2 3 4 Young Adults (ages 22-39 years) 1 2 3 4 Adults (ages 40-64 years) 1 2 3 4 Older Adults (ages 65-79 years) 1 2 3 4 Elderly (ages 80+ years) 1 2 3 4 AuthorizationsSignature(Required)The information I have given is true and accurate to the best of my knowledge. I hereby authorize Hired by Matrix, Inc. to release this Sleep Tech Skills Checklist to Client facilities of Hired by Matrix, Inc. in consideration of my assignment to work at those facilities.
