Breadcrumb Home Other Checklists Sterile Processing Technologist Form Information Info Name * Last 4 digits of SSN * Contact Phone * Email * Proficiency Scale 1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently processing Single Instruments * Endoscopes * Repair * Sets/Trays * Care of Instruments * Other (list): * Decontamination Manual Cleaning * Washer Sterilizer * Soiled Linen * Disinfectants * Sharps * Disposable Items * Cleaning Equipment * Detergents * Dress Code * Other (list): * Steam Sterilization Chart Recording * Biological Monitoring * Time * Testing/Monitoring * Other (list): * Tests Test Control * Recording * Other (list): * Assembly And Preparation Wrapping Materials * Autoclave Tape * Dust Covers * Proper Towel/Linen Folding * Proper Labeling * Expiration Dates * Packing for Steam * Heat Sealing * Instrument Count Sheets * Placing Instruments on Trays * Other (list): * Age Specific Competencies Infant (Birth - 1 year) * Preschooler (ages 2-5 years) * Childhood (ages 6-12 years) * Adolescents (ages 13-21 years) * Young Adults (ages 22-39 years) * Adults (ages 40-64 years) * Older Adults (ages 65-79 years) * Elderly (ages 80+ years) *