DATE

HANDS-ON EVALUATION
For use of this form, see STP 11-25S14-SM-TG; the proponent agency is TRADOC. 27 July 2020
TASK TITLE TASK NUMBER
Perform First Aid for Burns
081-831-1007
SCORE
(Check One)
ITEM PERFORMANCE STEP TITLE
PASS FAIL
a b c d
1. Eliminate the source of the burn
P F

2. Uncovered the burn, unless clothing was stuck to the

wound or in a chemical environment. P F

3. Applied the casualty's dressing.

P F

3a. Applied the dressing/pad directly over the wound.

P F

3b. Covered the edges of the dressing/pad.

P F

3c.
Properly secured the bandage. P F

3d. Applied the dressing lightly over the burn but

firmly enough to prevent slipping. P F

4. Watched the casualty closely for life-threatening

conditions, checked for other injuries (if necessary), and P F
treated for shock. Sought medical aid.

P F

P F

P F

P F

P F

P F

EVALUATOR'S NAME UNIT

SGT Luke Layton A Co. 24th MI BN
SOLDIER'S NAME STATUS
GO NO GO
DA FORM 5164-R, SEP 1985 EDITION OF DEC 82 IS OBSOLETE APD LC v2.01