Emergency Medical Technician Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlySkillsVital Sign - PULSE(Required) 1 2 3 4 Vital Sign - RESPIRATION(Required) 1 2 3 4 Vital Sign - LUNG SOUNDS(Required) 1 2 3 4 Vital Sign - BLOOD PRESSURE(Required) 1 2 3 4 Vital Sign - PULSE OXIMETRY(Required) 1 2 3 4 Basic Airway - OROPHARYNGEAL AIRWAY (OPA)(Required) 1 2 3 4 Basic Airway - NASOPHARYNGEAL AIRWAY (NPA)(Required) 1 2 3 4 Basic Airway - ORAL SUCTIONING(Required) 1 2 3 4 Basic Airway - BAG VALVE MASK(Required) 1 2 3 4 Basic Airway - OXYGEN ADMINISTRATION(Required) 1 2 3 4 Advanced Airway - MULTI-LUMEN AIRWAY (COMBI-TUBE)(Required) 1 2 3 4 Patient Assessment - TRAUMA(Required) 1 2 3 4 Patient Assessment - MEDICAL(Required) 1 2 3 4 Bleeding Control/Shock Management(Required) 1 2 3 4 PNEUMATIC ANTI SHOCK GARMENT (MAST)(Required) 1 2 3 4 Spinal Immobilization - B/B (SUPINE PT.)(Required) 1 2 3 4 Spinal Immobilization - KED (SEATED PT.)(Required) 1 2 3 4 Helmet Removal - FOOTBALL(Required) 1 2 3 4 Helmet Removal - MOTORCYCLE(Required) 1 2 3 4 Splinting - LONG BONE(Required) 1 2 3 4 Splinting - BIPOLAR TRACTION (HARE)(Required) 1 2 3 4 Splinting - UNIPOLAR TRACTION (SAGER)(Required) 1 2 3 4 Scoop Stretcher(Required) 1 2 3 4 BLS/ALS - Cardiac Arrest Management (AED)(Required) 1 2 3 4 BLS/ALS - Nitroglycerin Administration (NTG)(Required) 1 2 3 4 BLS/ALS - Epinephrine Administration (EPI)(Required) 1 2 3 4 CPR - ADULT / CHILD / INFANT(Required) 1 2 3 4 FBAO - ADULT / CHILD / INFANT(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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