Endoscopy/GI Lab Skills Checklist Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastPlease enter your full legal name as it appears on your Social Security Card.Email *Phone No experience: requires education, training and supervision Intermittent experience: may need support or supervise Proficient: consistent experience, independent Expert level: can teach/supervise others. Work SettingsAmbulatory Endoscopy center1234Inpatient endoscopy1234Outpatient Endoscopy center1234Pediatric Endoscopy1234Pre/Post Procedure1234Emergency ManagementPre Procedure 1234Post Procedure1234Fire Safety1234Latex Allergy1234EquipmentCO2 regulators1234Cytology brushes1234Decompression tubes1234Dilators1234Forceps1234Foreign body equipment1234Gastrostomy buttons1234Gastrostomy tubes1234Polyp snares1234Medication AdministrationBenzodiazepines1234Emergency Medications1234Lidocaine Throat Spray1234Opioid Analgesics1234Propofol1234Reversal agents1234Versed1234Pre-Procedure12 Lead EKG1234Colon prep1234Informed consent1234Patient assessment1234Starting IVs1234Post-ProcedureAirway Management1234Follow Up Phone Calls1234Recover Conscious Sedation1234Recover Monitored Anesthesia Care Sedation1234ProceduresBravo / pH monitoring1234Bronchoscopy1234Circulate1234Colonoscopy1234Cricopharyngeal Myotomy1234Double Balloon Enteroscopy (DBE)1234Endoscopic Ablation1234Endoscopic Retrograde Cholgio-Pancreatography (ERCP)1234Endoscopic Stent Placement1234Endoscopic Submucosal Dissection (ESD)1234Endoscopic Ultrasound1234Esophageal dilation1234Esophageal Manometry1234Esophageal Varices and Banding1234Esophagogastroduodenoscopy (EGD)1234Hot and Cold Biopsy1234Liver Biopsy1234Percutaneous Endoscopic Gastrostomy (PEG) Insertion/Replacement1234Peroral Endoscopic Myotomy (POEM)1234Polypectomy1234Replacement of Gastrostomy Buttons1234Replacement of Gastrostomy Tubes1234Scrub1234Sigmoidoscopy1234Single Balloon Enteroscopy (SBE)1234TEE (Transesophageal Echocardiography)1234Transoral incisionless fundoplication (TIF)1234Professional Knowledge and SkillsAdministering Conscious Sedation1234Electrosurgical Safety1234Infection Control1234Instrument Processing /Cleaning1234Interpretation and communication of lab values1234Monitoring Conscious Sedation1234National Patient Safety Goals/Core Measures1234Pain assessment & management1234Radiation Safety1234Specimen Handling/labeling1234Sterilization/Disinfection1234Telemetry Interpretation1234Universal Protocol (Time out) Procedure1234COMPUTERIZED CHARTINGCerner1234EPIC1234McKesson1234Meditech1234Allscripts1234OASIS1234MIDAS1234Other :1234If other, Please specify :Age specific competencyNeonate1234Infant1234Child1234Adolescent1234Young Adult1234Middle Adult1234Older Adult1234Submit