SELF EVALUATION
HISTOLOGY
SKILLS PROFICIENCY CHECKLIST

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If you prefer, you can print a form to fax or mail.
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     Last Name: 
    First Name: 
Middle Initial: 
 Years Experience

DIRECTIONS: Place an x in the box that best describes your level of proficiency for each of the skills presented.

LEVELS OF PROFICIENCY KEY:

HP =

Highly Proficient.
Extensively experienced; able to supervise and/or train others.

 SE =

Some Experience.
Need review and assistance or supervision.
VE =

Very Experienced.
Can perform well without assistance or supervision.

 NE = No Experience.
EX =

Experienced.
Competent; can perform independently; may need initial review or supervision.
GENERAL PROCEDURES: HP VE EX SE NE SPECIAL STAINS: HP VE EX SE NE
Embedding Giemsa
Cutting 2-5 microns Methenamine Silver
Coverslipping Masson’s Trichrome
Routine Staining H+E Oil Red O
Iron
OTHER PROCEDURES: Alcian Blue
Microwave Staining Verhoeff’s Elastic
Frozen Sections PAS
Cytospins AFB
Autostainer Crystal Violet
Auto Coverslipper Brown-Hopp’s Modification
Immunohistochemistry of Gram Stain
CAP Inspections Gomoris Retic
Other: Fontanna-Masson for Melanin
Other: and Argentaffin Granules
LIST OTHER AREAS OF SPECIALTY AND EXPERIENCE: 
Submitted by:      Date: 
Phone / Email:

© Rapid Temps, Inc., rev Feb-2000
 
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