Skills Inspection Checklist Template printable pdf download

SKILLS CHECK LIST

NOTE:

denotes a skill you might be tested on during your State of WI Skills Exam

NOTE: Raising the bed between mid-thigh and waist level during skills to protect your back is optional BUT recommended!

HAND WASHING – page 70

___ 1 Knock on the door. IF A CLIENT IS PRESENT -Address client by name and introduce yourself to client by name

___ 2 Gather supplies: soap and paper towels

___ 3 Remove your watch, or push it up on your forearm, and roll up or push up your sleeves

___ 4 Turn on the water at sink with a clean, dry paper towel and adjust the temperature until it is comfortably warm.

___ 5 Put your hands under the running water to wet your hands and wrists thoroughly keeping them lower than your elbows

___ 6 Apply antimicrobial soap from the dispenser to your hands

___ 7 Interlace fingers pointing downwards while rubbing your hands together vigorously to work up a lather

___ 8 Lather all surfaces of wrists, hands, fingers and nails producing friction

___ 9 Grasp wrists and circle with your other hand, scrub palms, backs of hands, areas between fingers

___ 10 Clean fingernails by rubbing fingertips against palms of the opposite hand

___ 11 After lathering for at least 20 (twenty) seconds, rinse all surfaces of wrists, hands, and fingers keeping hands lower than the

elbows and the fingertips down

___ 12 Use a clean, dry paper towel/towels to dry all surfaces of hands, wrists, and fingers (starting at the fingertips and moving back)

Towards the elbow then dispose of paper towel into waste container

___ 13 Use a SECOND clean, dry paper towel to turn off faucet then dispose of paper towel into waste container or uses knee/foot control

to turn off faucet. Exit by opening the door with your hip or shoulder. If there is a handle use a clean paper towel to open the door.

___ 14 Do not touch inside of sink at any time DO NOT RE-CONTANMINATE HANDS AT ANY POINT DURING PROCEDURE!

DONNING AND REMOVING PPE (GOWN AND GLOVES) – page 72

___ 1 Gather supplies, (gown, mask, gloves, plastic trash bag) and wash your hands

___ 2 Pick-up gown and unfold

___ 3 Slide your arms through each sleeve; keeping opening of the gown in back

___ 4 Securely fasten the ties at back of your neck

___ 5 Secure the gown at waist making sure the back of clothing is covered by gown (as much as possible)

___ 6 Put the mask over mouth and nose, and bend nose wire. Tie the top strings behind your head, then tie the bottom strings or place elastic

loops around ears. Adjust for comfort NOT NECESSARY DURING TESTING – NO MASK IS WORN

___ 7 Place the earpieces of the glasses over your ears or the headband around your head and adjust. NOT WORN DURING TESTING

___ 8 Inspect both gloves carefully for tears. Put gloves on carefully so they do not tear.

___ 9 Pull the gloves up over the cuffs of gown

___ 10 Before removing gown, with one gloved hand, grasps the other glove at the palm, and pull the glove towards the fingers of

your hand. Remove glove ONLY partway.

___ 11 Using your fingertips from the partially gloved hand grasp the gloved hand at the heel of hand removing glove turning it

inside out and rolling it into a ball in the palm of your gloved hand as it is removed

___ 12 With your bare hand, grasp the glove on your opposite hand, touching only the clean inside of the glove. Remove by pulling it down.

___ 13 Dispose of gloves into designated waste container without contaminating yourself

___ 14 Touch only the earpieces or the head band. Remove glasses and place in appropriate container NOT WORN DURING TESTING

___ 15 Carefully remove the gown without touching the outside of the gown. Unfasten the gown at the neck and then at the waist

___ 16 Pull off one sleeve by slipping your fingers under the cuff and pulling the sleeve just over your fingertips.

___ 17 Then grasp the other sleeve with covered hand and pull it off.

___ 18 Continue holding that sleeve in your covered hand. Grasp the inside of the first shoulder of the gown with your uncovered hand and

pull the gown off your shoulder. Hold the gown away from body without touching the floor. Continue to bring the gown forward.

Turn it inside out as you pull it over your covered hand.

___ 19 Fold the outer contaminated surface inward, rolling up the gown, dispose of gown in designated container without contaminating self

___ 20 Remove mask by untying the bottom strings, then the top strings or pull elastic loop from around ear. Hold by strings and dispose in

garbage. THIS STEP IS SKIPPED DURING TESTING – NO MASK IS WORN

___ 21 Wash your hands

Skills Inspection Checklist Template

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