First Aid
Skills Testing Checklist
Student Name __________________________________________________ Date of Test _______________________________
Scenario: “EMS has arrived and takes over. You may now remove your gloves. Demonstrate what you would do next.”
Removing Gloves
Grips one glove on the outside, near the cuff, to peel it off
Cups the inside-out glove with the gloved hand
Places 2 ngers of the bare hand inside the cuff to peel the second glove off, with the rst glove inside it
Verbalizes the need to dispose of gloves properly
Finding the Problem
Verbalizes that the scene is safe
Taps and shouts*
Shouts for help/Phones 9-1-1/Gets rst aid kit and AED
Checks breathing
Looks for injury and medical information jewelry
Verbalizes that he or she will stay with the person until EMS arrives
Scenario: “You find a coworker lying on the floor in the break room. There are a phone, first aid kit, and AED on the wall.
Demonstrate how you would find the problem.”
Using an Epinephrine Pen
Holds epinephrine pen in st
Takes off safety cap
Presses epinephrine pen rmly against outer side
of thigh for 10 seconds
Removes epinephrine pen
Rubs injection site for 10 seconds
*After the student taps and shouts, the instructor says, “The person is unresponsive.”
After the student verbalizes that he or she has checked for breathing, the instructor says, “The person is breathing
After the student checks for injury and medical information jewelry, the instructor says, “The person is not injured, and
there is no medical information jewelry.”
Scenario: “A coworker has a severe allergic reaction, has an epinephrine pen, and needs help using it. You have completed
all previous steps and are now ready to use the epinephrine pen. Demonstrate what you would do next.”
Stopping Bleeding and Bandaging
Tells person to place pressure over cut with clean dressing
Verbalizes putting on gloves
Applies pressure
to bleeding area*
Adds more dressings and presses harder
Applies more bandages over the dressing
Scenario: “You will demonstrate stopping bleeding and then bandaging a small cut on the person’s forearm. You have
the first aid kit and are now ready to begin.”
Instructor Notes
Place a in the box next to each step the student completes successfully.
If the student does not complete all steps successfully (as indicated by at least 1 blank check box), the student must receive
remediation. Make a note here of which skills require remediation (refer to Instructor Manual for information about remediation).
Test Results
Check PASS or NR to indicate pass or needs remediation:
Instructor Initials __________ Instructor Number _____________________________ Date _____________________________
© 2016 American Heart Association
*Instructor says, “The bleeding is not stopping.”
Instructor says, “The bleeding has stopped.”