1. Places instruments, equipment and supplies before, during, and after surgery to assist the surgical team.

2. Assists team members to place and position patient on the operating room table.

3. Scrubs arms and hands and dons gowns and gloves in prescribed manner.

4. Passes instruments and, supplies to surgeon, holds retractors, cuts sutures, and performs other tasks as directed by surgeon during surgical procedure.

5. Counts sponges, needles, blades, and instruments before beginning of case, before closing of incision, and again before closing the skin.

6. Washes gross contaminants from instruments after procedure and prepares them for the decontamination area.

7. Moves in and around sterile field without contamination.

8. Implements emergency procedures and administers first aid including CPR.

Physical Requirements: The position of the student Surgical Technologist has been given a strength rating of MEDIUM WORK by the US Dictionary of Occupational Titles (exerting up to 20-50 pounds of force occasionally, and/or 10-15 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects.) Included in the essential functions of this position are the lifting, carrying, positioning and moving of patients both manually and by stretcher. When performing these functions with large patients, the strength necessary may exceed the DOT rating. The student Surgical Technologist position also includes prolonged periods of standing, frequent bending, reaching, twisting, occasional sitting, and exposure to changes in temperature/humidity and fumes. Both hands are used for power grip, speed and precision work. Use of both feet is required.

                                             I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Data Conception: Requires the ability to gather, collate or classify information about data, people or objects. Reporting and/or carrying out a prescribed action in relation to the information is frequently involved.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Color Discrimination: Requires the ability to differentiate colors and shades of color.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Manual Dexterity/Motor Coordination: Requires the ability to use body members, tools or special devices to work, move, guide or place objects or materials. Involves some latitude for judgment with regard to precision attained and selecting appropriate tool, object, or material, although this is readily manifest. Must have good eye/hand/foot coordination.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Interpersonal Communication: Requires talking with and/or signaling people to convey or exchange information. Includes giving assignments and/or directions to helpers or assistants.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Physical Communication: Requires the ability to speak and hear (express self by spoken words and perceive sounds by ear.)

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Reasoning Development: Requires ability to apply principles of logical or scientific thinking to define problems, collect data, establish facts, and draw valid conclusions. Interpret an extensive variety of technical instructions in mathematical or diagrammatic form. Deal with several abstract and concrete variables.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Language Development: Requires ability to read and understand complex information from scientific and/or technical journals, papers, etc. Requires the ability to communicate the same types of complex information and data through speech and in writing using proper format, punctuation, spelling, grammar and using all parts of speech.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Numerical Ability: Requires the ability to determine time, weight and to perform practical applications of fractions, percentages, ratio and proportion as well as basic addition, subtraction, multiplication, and division operations.

                                           I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Form/Spatial Ability: Requires the ability to inspect dimensions of items and to visually read information and data.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Personal Temperament: Requires the ability to deal effectively with stress produced by work and guest interaction situations that may be of critical or emergency situation.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Physical Exam 1: Requires the submission of a completed medical examination form before beginning classes.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

                                             I am capable of meeting these requirements with the following accommodations:

Physical Exam 2: Requires the individual to be able to meet size requirements of being able to fit into designated sterile attire. Maximum size stocked in OR is XXL in both cloth and disposable gowns.  A 3XXL is available in disposable but is not a stock item at any hospital and would be responsibility of student to purchase.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

*Physical Restriction: An individual is constantly exposed to various forms of latex in the operating room setting. Known and or developed latex allergy may result in a potential life-threatening situation.

                                            I am capable of meeting these requirements

                                             I am not capable of meeting these requirements

STUDENT'S SIGNATURE DATE _____________________________________
 

SOCIAL SECURITY NUMBER _______________________________________