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Radiography Skills Self Evaluation

Name:

Signature:

Date:

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1 - No Experience

2 - Minimal

3 - Moderate

4 - Very Experienced

Radiography

Head/Skull

Orbitz

Mandible

Facial Bones

Nasal Bones

Zygoma

Mastoids

Spine/Pelvis

Cervical Spine

Lumbar Spine

Thoracic Spine

Scoliosis

Thorax

Sternum

PA / Lat Chest

Ribs

Decubitus Chest

Chest 2V

Abdomen

Erect / Decubitus

Abdominal Series

Extremities

Small Extremities

Large Extremities

Pediatric

Chest / Abdomen

Extremities

Heads

Spine

Fluoroscopy / Special Exams

IVP / Tomograms

Myelogram

Hysterosalpingogram

Bronchogram

Cholangiogram

Gall Bladder

Sialogram

Uethogram

Arteriograms

Venogram

Trauma

Surgery

C-Arm Portables

Swallowing Functions

GI Upper / Lower

Age Specific Criteria

Newborn/Neonatal (up to 30 days)

Infant (30 days to 1 year)

Toddler (1 to 3 years)

Preschooler (3 to 5 years)

School Age (5 to 12 years)

Adolescents (12 to 18 years)

Young Adults (18 to 39 years)

Middle Adults (40 to 64 years)

Older Adults (65 & up)

Facility Setting

Years experience

Small Hospital

Large Hospital

Outpatient

Clinic

Certification / Registries

Date

ARRT Expiration Date

MRI Expiration Date

RDCS Expiration Date

CT Expiration Date

Mammography Expiration Date

Fluoroscopy Expiration Date

BCLS Expiration Date

ACLS Expiration Date

Eligible

Other

Equipment Used

Software Used

Employee Signature

Date