EEG Technician Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyAGE OF PATIENTS CARED FORNewborn/Neonate (birth to 30 days)(Required) 1 2 3 4 Infant (1 month to 1 year)(Required) 1 2 3 4 Toddler (1 year to 3 years)(Required) 1 2 3 4 Preschooler (3 years to 5 years)(Required) 1 2 3 4 School Age Child (5 years to 12 years)(Required) 1 2 3 4 Adolescents (12 years to 18 years)(Required) 1 2 3 4 Young Adults (18 years to 39 years)(Required) 1 2 3 4 Middle Adults (39 years to 64 years)(Required) 1 2 3 4 Older Adults (64 years to 79 years)(Required) 1 2 3 4 Elderly Adults (over 79+ years)(Required) 1 2 3 4 GENERAL SKILLSStandard Precautions(Required) 1 2 3 4 Isolation Precautions(Required) 1 2 3 4 Pediatric Respiratory/Cardiac Arrest(Required) 1 2 3 4 Adult Respiratory/Cardiac Arrest(Required) 1 2 3 4 Crash Carts(Required) 1 2 3 4 Defibrillators(Required) 1 2 3 4 Electronic Documentation(Required) 1 2 3 4 Automated Med Dispensing Systems(Required) 1 2 3 4 BASIC SKILLS10-20 Electrode Placement(Required) 1 2 3 4 Portable Recording in Adult ICU(Required) 1 2 3 4 Portable Recording in Pediatric ICU(Required) 1 2 3 4 Portable Recording in NICU(Required) 1 2 3 4 ECI-Brain Death Recording(Required) 1 2 3 4 Ambulatory EEG(Required) 1 2 3 4 Sleep Deprived EEG(Required) 1 2 3 4 Sleep EEG(Required) 1 2 3 4 EMG(Required) 1 2 3 4 EVOKED POTENTIALSSomatosensory Evoked Potential (SSEP)(Required) 1 2 3 4 Motor Evoked Potential(Required) 1 2 3 4 Visual Evoked Potential(Required) 1 2 3 4 Auditory Evoked Potential(Required) 1 2 3 4 Assist with Nerve Conduction Studies/EMG(Required) 1 2 3 4 EQUIPMENTPaper Machine Experience(Required) 1 2 3 4 Digital Machine Experience(Required) 1 2 3 4 Nicolet(Required) 1 2 3 4 Grass(Required) 1 2 3 4 Xltek(Required) 1 2 3 4 Nihon Kohden(Required) 1 2 3 4 DOCUMENTATIONObtain Patient History(Required) 1 2 3 4 Changes in Patient Status(Required) 1 2 3 4 Stimulation(Required) 1 2 3 4 Hyperventilation(Required) 1 2 3 4 Post Hyperventilation(Required) 1 2 3 4 Interpreting EEG Patterns(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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