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Respiratory Therapist

    Instruction

    Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below)

  • 0 = No theory and/or experience
  • 1 = Limited experience/need supervision and/or support
  • 2 = Experienced/minimal support needed to perform)
  • 3 = Proficient/can perform independently
  • 4 = Expert/very experienced in the field
Recruiter Information

Recruiter TEEMA email

Personal Information

Full Name

Email

Phone number

Date

General Skills

Care of Patient in Restraints

Electronic Documention

Isolation Precautions

Medicare Documentation

Patient/Family Education

Written Documentation

Care of Patients With

Acute/Chronic Bronchitis

ARDS

Aspiration Pneumonia

Asthma

Atelactasis

Bacterial/Viral Pneumonia

Bronchiectasis

Broncho-Pulmonary Dysplasia

Cardiac Surgery

Congestive Heart Failure

Croup

Cystic Fibrosis

Diabetic Ketoacidosis

Emphysema

Epiglottitis

Failure to Thrive

Fem-pop Bypass

Gullian Barre

Hayaline Membrane Disease (HMD/IRDS)

Lung Cancer

Meconium Aspiration

Myasthenia Gravis

Myesthena Gravis

Myocardial Infraction

Near Drowning

Neonatal Pneumonia

Open Hearts

Pacemakers

Persistant Fetal Circulation

Pulmonary Interstitial Emphysema (PIE)

Pleural Effusion

Pulmonary Edema

Pleural Embolism

Respiratory Failure

Respiratory Syncytial Virus

Respiratory Distress Syndrome

Tracheo-Esophageal Fistula

Transient Tachpnea

Thoracotomies

Tuberculosis

Therapy and Procedures

Apnea Monitor

Assessment of Breath Sounds

Carbogen Delivery

Diaphragmatic Breathing

Disinfection and Sterilization

End-Tidal CO2 Monitoring

Nasal-Oral Airway Placement

Oximetry

Pursed Lip Breathing

Transcutaneous Monitoring

Oxygen Administration

Acapella

Aerosol Set Up/Mask/Trach

Analyze Oxygen

BiPAP Nasal/Mask

Bronchial Hygiene Therapy

Chest Physical Therapy/Postural Drainage

CPAP Nasal/Mask

Continuous Medication Nebulizer

Cough Assisted machine

Croup Tent Set Up

EzPAP Expansion Therapy

Flutter Valve Therapy

Hand Held Nebulizer

Heated Aerosol Mask/Trach Collar

Heliox Delivery

Incentive Spirometry (IS)

Infant Hood Set Up

Intrapulmonary Percussive Ventilation (IPV)

Metered Dose Inhaler

Nasal Cannula

Nitric Oxide Delivery

Oxygen Tank Set Up/Change Tank

Partial Rebreather/Non-Rebreather Mask

PEP Mask/PEP Valve Therapy

Positive Pressure Breathing (IPPB)

Simple Mask

Splint Cough

Sputum Induction

Venturi Mask

Vest Airway Clearance

Obtaining Arterial Blood Gases

ABG Interpretation/Analyzer

Airway Pressure Release Ventilation (ARPV)

Allen Test

Arterial Blood Gas Analysis

Arterial Line Insertion

Arterial Line Maintenance

Bronchoscopies/Assist

Change, Clean Trach Tubes

Check Intracuff Pressures

Continuous Positive Airway Pressure (CPAP)

Endotracheal

Extubations

Assist Only

Femoral Artery

Flow/Volume/Pressure Waveform Interpretation

High Frequency Ventilator

Independent Synchronous Lung Ventilation

Inhaler Reservoirs

Intra Aortic Balloon Pump (IABP)

Intubations

Perform Independently

Inverse Ratio Ventilation

Nasotracheal

Negative Inspiratory Force

Peak Flow Rat Monitoring

Positive End Expiratory Pressure (PEEP)

Pressure Assist/Control

Pressure Regulated Volume Control (PRVC)

Pressure Support Ventilation (PSV)

Pulmonary Function Testing

Pulmonary Stress Testing

Radial/Brachial Artery

Vendtilator Management

Intermittent Mandatory Ventilation (IMV)

Inverse Ratio Ventilation

Pressure Release Modes/Techniques

Suctioning

Synchronized Intermittent Mandatory Ventilation (SIMV)

Ventilate Patient with Manual Resucitator

Ventilator Modes

Ventilator Set Up/On Tanks

Volume Assist/Control

Other

Settings

Acute Care

Adult Critical Care Unit

Burn ICU

Emergency Room

Home Care

Medical/Surgical General Floor Care

Neonatal ICU Level I

Neonatal ICU Level II

Pediatric General Floor Care

Pediatric ICU

Pediatric ICU Level II

Pediatric ICU Level III

Pulmonary Rehabiliation

Pulmonary Function Lab

Skilled Nursing

Sleep Lab

Transplant

Transports

Equipment

Bird/Avea

Drager

Puritan-Bennett

Sechrist-Infant Star

Servo

Siemens

SIMS

Age

Newborn (birth - 30 days)

Infant (30 days - 1 year)

Toddler (1 - 3 years)

Preschooler (3 - 5 years)

School Age (5 - 12 years)

Adolescents (12 - 18 years)

Young Adults (18 - 39 years)

Middle Adults (39 - 64 years)

Older Adults (64+ years)

Please read and agree to the statements below by marking the checkbox.

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

Thank you for your submission, we will look over your message and get back to you ASAP.

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