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Skills Checklists

Congratulations on your decision to apply for an allied position with ClubStaffing! Before we can offer you an allied employment opportunity, an electronic skills assessment must be completed. From the skills checklist below, please locate the list that matches your specialty and complete the online form. Be sure to review your information thoroughly before clicking the submit button. Thank you!

ClubStaffing
5901 Broken Sound Pkwy.
Suite 450
Boca Raton, Florida 33487
Fax: (561) 367-0884


Cardiac Monitor Technician (non RNs) Skills Checklist

*
Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name* Middle Name Last Name*
E-Mail Address* Phone Number*
 
1. No experience; requires education, training and supervision
2. Intermittent experience; may need support or supervision
3. Proficient; consistent experience, independent
4. Expert level; can teach/supervise others
 
EXPERIENCE IN THE FOLLOWING SETTING(S)
1 2 3 4
 
Number of Monitors Responsible For
 
Remote Telemetry Office
 
Telemetry Unit (located on the unit)
 
Patient/ Equipment Preparation
1 2 3 4
 
Lead Placement - 3 Lead
 
Lead Placement - 5 Lead
 
Set up 12 Lead ECG
 
Set up Lead II
 
Set up MCL1
 
Skin prep
 
Interpret the Following Rhythms
1 2 3 4
 
1st Degree Heart Block
 
2nd Degree Heart Block Type I
 
2nd Degree Heart Block Type II
 
3rd Degree Heart Block
 
Asystole
 
Atrial Fibrillation
 
Atrial Flutter
 
Bundle Branch Block
 
Junctional Rhythms
 
Measure Cardiac Intervals (PR, QRS, ST, etc.)
 
Measure Cardiac Rate
 
Normal Sinus Rhythm
 
Paced Rhythms - Atrial/Ventricular/AV
 
Pacemaker- Failure to Capture
 
Pacemaker Misfire
 
Premature Atrial Contractions
 
PVC - Unifocal/Multifocal
 
PVC- Bigeminy/Trigeminy/Coupling
 
Sinus Arrest
 
Sinus Bradycardia/Sinus Tachycardia
 
Ventricular Fibrillation
 
Ventricular Tachycardia
 
Monitoring Systems Used
1 2 3 4
 
GE
 
Philips
 
Spacelabs
 
Other: Specify
 
Other: Specify
 
MISCELLANEOUS
1 2 3 4
 
Cardiac Arrest Protocol
 
Computerized Charting
 
CERTIFICATIONS (Current at time of this form being filled out)
 
BLS
 
Telemetry Interpretation Course: (indicate date taken)
 
Other: Specify
Cardiac Monitor Technician (non RNs) Skills Checklist, version 3

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. Falsification of any information provided, will result in being ineligible to travel with AMN. 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.

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