Heartsaver
®
Child CPR
Skills Testing Checklist
Student Name __________________________________________________ Date of Test _______________________________
Scenario: “You are home alone with a child, and the child suddenly collapses in front of you. The scene is safe and you
have a cell phone with you, but no AED nearby. Demonstrate what you would do next.”
Assessment and Activation
☐
Checks responsiveness
☐
Shouts for help/Phones 9-1-1 on cell phone
☐
Checks breathing
Cycle 1 of CPR (30:2) *CPR feedback devices preferred for accuracy
Child Compressions
☐
Performs high-quality compressions*:
• Hand placement on lower half of breastbone
• 30 compressions in no less than 15 and no more
than 18 seconds
• Compresses at least one third the depth of the
chest, about 2 inches (5 cm)
• Complete recoil after each compression
Child Breaths
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Gives 2 breaths with a barrier device:
• Each breath given over 1 second
• Visible chest rise with each breath
• Gives 2 breaths in less than 10 seconds
Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed
☐
Gives 30 high-quality compressions
☐
Gives 2 effective breaths
STOP TEST
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:
PASS NR
Instructor Initials __________ Instructor Number _____________________________ Date _____________________________
© 2016 American Heart Association
Instructor says, “EMS has arrived and is taking over.”
Cycle 3 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed
☐
Gives 30 high-quality compressions
☐
Gives 2 effective breaths
