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TELEPRACTICE

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Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

Phlebotomist Skills Checklist

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only

1 = Limited Experience / Rarely Done (<6 times/year)

2 = May Need Some Review / Occasionally Done (1-2 times/month)

3 = Experienced / Frequently Done (daily or weekly)

"*" indicates required fields

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Full Name*

Email*

Todays Date*

MM slash DD slash YYYY

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)

0

1

2

3

Infant (31 days to 12 months)

0

1

2

3

Toddler/Preschool (13 months to 5 years)

0

1

2

3

School Age Child/adolescent (6 years to 18 years)

0

1

2

3

Young AdultsMiddle Adult (19 years to 64 years)

0

1

2

3

Older Adults/Elderly (65+ years)

0

1

2

3

General Skills

Standard Precautions

0

1

2

3

Isolation Precautions

0

1

2

3

Do you have charge/supervisor experience?

Yes

No

Knowledge of "Do Not Use Abbreviations"

0

1

2

3

Knowledge of current Joint Commission National Patient Safety Goals

0

1

2

3

Knowledge/familiarity with HCAHPS scores

0

1

2

3

IV Pumps

Alaris

Alibaba

Bard

Baxter

Braun

CADD

IVAC

Zynomed

N/A

Other IV Pumps:

Experience

Hospital Laboratory

0

1

2

3

Clinic Experience

0

1

2

3

Blood Bank

0

1

2

3

Patient Identification

Inpatient Identification

0

1

2

3

Infants and Young Children Identification

0

1

2

3

Emergency Department Identification

0

1

2

3

Ambulatory patient Identification

0

1

2

3

Equipment

Alcohol Swabs

0

1

2

3

Arterial Blood Gas Kits

0

1

2

3

Cotton Swabs

0

1

2

3

Occult Blood Packets

0

1

2

3

Heel Warmers

0

1

2

3

Infant Restraints

0

1

2

3

Laboratory Requisitions

0

1

2

3

Serum Separators

0

1

2

3

Vacutainer holder

0

1

2

3

Vacutainer Tubes

0

1

2

3

Order of Tubes

0

1

2

3

Blood Culture Bottles

0

1

2

3

Blood Culture Preparation Kits

0

1

2

3

Centrifuge

0

1

2

3

24 Hour Urine Containers

0

1

2

3

Capillary Blood Kits

0

1

2

3

Bacteria Media

0

1

2

3

Drug Screen Kits

0

1

2

3

Ova parasite Containers

0

1

2

3

Legal Blood Draw Kits

0

1

2

3

Paternity Blood Draw Kits

0

1

2

3

RSV Kits

0

1

2

3

Glucola

0

1

2

3

Complications/troubleshooting

Fainting

0

1

2

3

Hematoma

0

1

2

3

Failure to Draw Blood

0

1

2

3

Petechiae

0

1

2

3

Excessive Bleeding

0

1

2

3

Mastectomy

0

1

2

3

Edema

0

1

2

3

Collapsed Veins

0

1

2

3

Hemolysis

0

1

2

3

Burned or Scarred Areas

0

1

2

3

awards updated 2022

SIA_CM_Member_2018

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