OR First Assist (ORFA) 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)

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)

MM slash DD slash YYYY

First Assist Experience With The Following Ages

Newborn/Neonate (birth to 30 days)
Infant 31 days to 12 months)
Toddler/Preschool (13 months to 5 years)
School Age Child/adolescent (6 years to 18 years)
Young Adults/Middle Adult (19 years to 64 years)
Older Adults/Elderly (65+ years)

General Skills

Automated Med Dispensing Systems
Electronic Documentation
IV Pumps
Peripheral IV Insertion, Care and Maintenance
Access/Management of Implanted Ports
Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
Time Out Procedure Pre-Op
Knowledge of "Do Not Use Abbreviations"
Do you have charge/supervisor experience?

General Surgery-first Assist With Following

Abdominal Perineal Resection
Bowel Resection
Cholecystectomy
Gastrectomy
Herniorrhaphy-Femoral/Inguinal, ventral, umbilical
Hiatal Herniorrhaphy-Transabdominal
Laparoscopic General Surgeries
Organ Procurement
Radical Mastectomy
Breast biopsy
Appendectomy
Gastric Bypass
Splenectomy
Thyroidectomy
Tracheostomy

Laparoscopic Procedures-first Assist With Following

Cholecystectomy
Appendectomy
Hysterectomy
Hernia Repair
Colon Resection

Gynecology-first Assist With Following

Cesarean Section
Dilation & Curettage
Hysterectomy-Vaginal
Hysterectomy-Abdominal
Laser Surgery
Salpingo-Oopherectomy
Tubal Ligation
Vaginectomy
Vaginal Reconstruction

G.u. And Cysto-first Assist With Following

Circumcision
Cystoscopy/Cystostomy
Cystectomy
Hypospadius Repair
Lithotripsy
Nephrectomy
Orchiectomy
Penile Implant
Prostatectomy
Ureterolithotomy
T.U.R.P./T.U.R.B.
Vasectomy

Orthopedic-first Assist With Following

Anterior Cruciate Ligament Reconstruction
Carpal Tunnel surgery
Arthroscopy/Arthrotomy
Closed Pinning & Reduction of Extremities
External Compression Devices
Total Joint Replacement - Knee, Hip
Spinal Fusion-Harrington Rods
Spica Cast Application
O.R.I.F.-Shoulder, Hip, Humerus etc.
Patellectomy
Tendon Implants & Reanastomosis

Neurosurgery-first Assist With Following

Anterior Cervical Fusion
Burrholes for Subdural Hematoma
Craniotomy
Laminectomy
Shunt Procedures-VP/VA

Plastics-first Assist With Following

Abdominoplasty/Abdominal Lipectomy
Augmentation Mammoplasty
Cleft Lip/Palate Repair
Facelift
Liposuction
Otoplasty
Rhinoplasty
Reduction of Facial Fracture
Scar Revision
Skin Meshing
Split Thickness Skin Grafting

Eye-first Assist With Following

Excision of Chalazion
Canthotomy
Correction of Ectropian/Entropian
Corneal Transplant
Enucleation
I.O.I. Implants
Lacrimal Duct Probing
Refractive Keratoplasty
Repair of Retinal Detachment
Vitrectomy

Ear, Nose & Throat-first Assist With Following

Caldwell-Luc
Ethymoidectomy
Frontal Flap Sinus Procedure
Laryngectomy
Open Reduction Facial Fractures
Radical Neck
Tonsillectomy & Adenoidectomy
Myringotomy
Mastoidectomy
Tympanoplasty
Stapedectomy
Nasal Polypectomy
Laryngoscopy

Thoracic-first Assist With Following

Hiatal Hernia
Pneumonectomy/Lobectomy
Esophagogastrectomy
Thoracotomy
Endoscopic Thoracic Procedures
Lung/Wedge Resection

Endoscopy-first Assist With Following

Bronchoscopy
Upper Endoscopy (EGD)
Cystoscopy
Gastroscopy
Colonoscopy

Cardiovascular-first Assist With Following

A-V Shunts
Aortic Aneurysm, Abdominal
Aorto-Femoral-Pop Bypass Graft
Cardiac Valve Replacement
Coronary Artery Bypass Graft-on pump
Coronary Artery Bypass Graft-off pump
Endarterectomy-Carotid/Femoral
Femoral-Popliteal Bypass
Permanent Pacemaker Implant
Intra-Aortic Balloon Pump Catheter
Patent Ductus Repair
Pericardial Windows
Portasystemic Shunt
Repair of Septal Defects
Thrombectomy
Vena Cava Ligation

Transplants-first Assist With Following

Pancreas
Heart
Lung
Liver
Kidney
Eye

Wound Closure-first Assist With Following

Suturing
Stapling

Equipment -First Assist With Following

Robotics
Fracture Tables
Video Systems
CUSA
Cell Saver
PACS Diagnostics
Electrocautery
Drills
Stapling Devices
Ventilators
Cardiac Monitors
Stapling Devices