Interview Outcome Form

Candidate Name*
First Last
Specialty*
- Endoscopy
- ENT
- Audiology
- Outpatients
- Oral Surgery
- Vascular Surgery
- Orthopaedics
- General Surgery
- Theatres & Ward
- Gynaecology
- Ophthalmology
- Radiology
- Dermatology
- Urology
- Nurse in Charge and Senior Nurse
Interview Type*
- Jobatar
- Telephone
- CV review (Project staff)
Name of Interviewer*
Candidate Application Form Reviewed*
- Yes
- No
Date of Interview*
DD slash MM slash YYYY
Role(s) Applied For*
- Endoscopy Nurse
- Nurse Endoscopist
- Decontamination Technician
- Endoscopy HCA (Procedure Room)
- Specialist Screening Practitioner
- Surgery Pre Assessment Nurse
- Endoscopy Pre Assessment Nurse
- Recovery Nurse
- Operating Department Practitioner
- Ward Nurse
- Gynaecology Ward Nurse
- Urogynaecology HCA
- Urogynaecology Nurse
- Urogynaecology Nurse in Charge
- Theatre HCA
- Ward HCA
- Breast Surgery Scrub Nurse
- ENT Scrub Nurse
- General Surgery Scrub Nurse
- Gynaecology Scrub Nurse
- Ophthalmology Scrub Nurse
- Oral Surgery Scrub Nurse
- Orthopaedic Scrub Nurse
- Urology Scrub Nurse
- Vascular Scrub Nurse
- Non-medical Surgical Assistant
- Audiologist
- Dental Nurse
- Glaucoma Outpatient Nurse
- Cataract Outpatient Nurse
- Medical Retina Outpatient Nurse
- Adnexal/Plastics Outpatient Nurse
- Intravitreal Injection Nurse
- Ophthalmology Ward Nurse
- Ophthalmology Pre-assessment Nurse
- Laser Glaucoma PI/Yag Caps Nurse
- General Ophthalmology Outpatient Nurse
- Ophthalmic Technician
- Ophthalmology HCA
- Dermatology Outpatient Nurse
- Dermatology Surgical Nurse
- Dermatology Wound Clinic Nurse
- Dermatology HCA
- Outpatient Nurse
- Outpatient HCA
- Endoscopy Nurse in Charge
- ENT Outpatient Nurse in Charge
- Dermatology Nurse in Charge
- Ophthalmology Nurse in Charge
- Outpatient Nurse in Charge
- Surgery Nurse in Charge
- Radiographer
- Sonographer
- Mammographer
- Sterile Services Technician
- Clinical Nurse Specialist
Essential Competencies Acceptable*
- Yes
- No
Please read the essential competencies form and check candidate meets ALL criteria for ALL roles applied for above
Interview questions and answers
1: Key priorities on 18WS NIC shift 2. Allegation of staff bullying 3. How to run Morning Huddle 4. How would you manage conflict within the team 5. Patient Safety 6. Who is responsible for reporting risks:
Outcome
Decision*
- Pass
- Fail
Endoscopy Role(s) Approved*
- Endoscopy Nurse
- Endoscopy Senior Nurse
- Nurse Endoscopist
- Endoscopy Nurse in Charge
- Endoscopy Pre-Assessment Nurse
- Endoscopy Nurse (EUS)
- Endoscopy HCA (Procedure Room)
- Bowel Screening Practitioner
- Endoscopy Decon (Cantel Cabinet)
- Endoscopy Decon (Gettinge Cabinet)
- Endoscopy Decon (Gettinge Washer)
- Endoscopy Decon (Isis Washer)
- Endoscopy Decon (Lancer Washer)
- Endoscopy Decon (Olympus Cabinet)
- Endoscopy Decon (Olympus Washer)
- Endoscopy Decon (Rapid AER Washer)
- Endoscopy Decon (Soluscope Washer)
- Endoscopy Decon (Steelco Washer)
- Endoscopy Decon (Sterise Washer)
- Endoscopy Decon (Waasenberg Cabinet)
- Endoscopy Decon (Waasenberg Washer)
ENT Role(s) approved*
- ENT Scrub Nurse
- ENT Outpatient HCA
- ENT Outpatient Nurse in Charge
- ENT Outpatient Senior Nurse
Audiology Role(s) approved*
- Audiologist
Audiology Competencies*
- Advanced Audiology
- Hearing Aid Service
- Micro-suction
- Vestibular Service
Outpatients role(s) approved*
- Outpatient HCA
- Outpatient Nurse
- Outpatient Nurse in Charge
- Outpatient Senior Nurse
- Clinical Nurse Specialist
Oral Surgery role(s) approved*
- Oral Surgery Dental Nurse
- Oral Surgery Scrub Nurse
- Oral Surgery Nurse in Charge
Vascular Surgery Role approved*
- Vascular Surgery Scrub Nurse
Orthopaedics role approved*
- Orthopaedics Scrub Nurse
General Surgery role(s) approved*
- General Surgery Scrub Nurse
- Surgery Nurse in Charge
- Surgery Practitioner in Charge
- Surgery Pre-Assessment Nurse
- Surgery Pre-Assessment Senior Nurse
- Surgery Senior Nurse
Theatres & Ward role(s) approved*
- Operating Department Practitioner
- Recovery Nurse
- Theatre HCA
- Ward HCA
- Ward Nurse
Gynaecology role(s) approved
- Gynaecology Ward Nurse
- Gynaecology Scrub Nurse
- Gynaecology Senior Nurse
- Urogynaecology HCA
- Urogynaecology Nurse
- Urogynaecology Nurse in Charge
Ophthalmology role(s) approved*
- Ophthalmic Technician
- Ophthalmology HCA
- Ophthalmology Nurse (General Outpatient)
- Ophthalmology Nurse (Adnexal/Plastics Outpatient)
- Ophthalmology Nurse (Cataract Outpatient)
- Ophthalmology Nurse (Glaucoma Outpatient)
- Ophthalmology Nurse (Intravitreal Injection Nurse)
- Ophthalmology Nurse (Laser Glaucoma PI/YAG Caps)
- Ophthalmology Nurse (Medical Retina Outpatient)
- Ophthalmology Nurse (Ozurdex Injection)
- Ophthalmology Nurse (Pre-Assessment)
- Ophthalmology Nurse (Ward)
- Ophthalmology Nurse in Charge
- Ophthalmology Scrub Nurse
- Ophthalmology Senior Nurse
- Ophthalmology Nurse in Charge
Biometry skills (if applicable)*
- Ophthalmology Biometry A Scan
- Ophthalmology Biometry IOL Master 500
- Ophthalmology Biometry IOL Master 700
- Ophthalmology Biometry OCT
- Ophthalmology Biometry Visual Fields
Radiology role(s) approved
- Mammographer
- Radiographer
- Sonographer
- Radiology HCA
Dermatology role(s) approved*
- Dermatology HCA
- Dermatology Outpatient Nurse
- Dermatology Surgical Nurse
- Dermatology Wound Clinic Nurse
- Dermatology Senior Nurse
- Dermatology Nurse in Charge
Urology role approved*
- Urology Scrub Nurse
Scope Manufacturer
- Olympus
- Pentax
- Fujinon
Nurse in Charge and Senior Nurse role(s) approved
- Endoscopy Nurse in Charge
- Endoscopy Senior Nurse
- ENT Outpatient Nurse in Charge
- ENT Outpatient Senior Nurse
- Outpatient Senior Nurse
- Oral Surgery Nurse in Charge
- Surgery Nurse in Charge
- Surgery Practitioner in Charge
- Surgery Pre-Assessment Senior Nurse
- Surgery Senior Nurse
- Gynaecology Senior Nurse
- Ophthalmology Nurse in Charge
- Ophthalmology Senior Nurse
- Dermatology Nurse in Charge
- Dermatology Senior Nurse
Additional skills (if applicable)
- Competent in Mitomycin Administration
- Competent in Phlebotomy
- Competent in Skin Prick Testing
Reasons why candidate has passed or failed
Contact Owner

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18 Week Support

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Interview Outcome Form

Outcome

18 Week Support

London

Birmingham

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