EAST TENNESSEE STATE UNIVERSITY

RADIOGRAPHY PROGRAM

TECHNICAL/PHYSICAL ASSESSMENT

In regard to technical assessment, candidates for admission to the radiography program must complete certain tasks that are required in the professional field.  During the mandatory radiography program orientation, this form will be distributed to each student.  The student is required to go through eight designated assessments that are stated below.  This form must be completed by the radiography program faculty and signed by the faculty evaluator, program director, and student. 

Student’s Name:  ____________________________________         Date:  ____________

______            1.         The applicant is able to lift and carry two cassettes in each hand

simultaneously.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

______            2.         The applicant is able to lift a minimum of 25 pounds from ground to waist

level and extend that weight out from the body at a minimum distance of 12 inches.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

______            3.         The applicant is able to push a portable x-ray machine and/or a stretcher

with a patient on it at least 50 feet.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

______            4.         The applicant is able to visualize objects at a distance of ten feet.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

______            5.         The applicant is able to elevate both arms and rotate the x-ray tube

to 90 degree angles in opposite directions.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

______            6.         The applicant is able to denote noises at a distance of fifteen feet.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

______            7.         The applicant certifies that they are able to walk and stand for a

period of eight hours.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

______            8.         The applicant is able to communicate verbally with others using

the English language.

A.        Completed with ease               

B.         Completed with little difficulty

C.        Completed with some difficulty

D.        Unable to perform

Comments:

Faculty Evaluator:  ________________________________               Date:  ____________

Program Director:  ________________________________               Date:  ____________

Student:  ________________________________________              Date:  ____________

Reasonable accommodations, in regard to the American Disability Act, will be provided to applicants with disabling conditions.  Students with further questions may contact the ETSU Office for Students with Disabilities at (423) 439-8346.