Far Eastern University

Institute of Nursing

PERFORMANCE EVALUATION TOOL FOR

BASIC LIFE SUPPORT
(CPR)

NAME: _____________________________________________________________ SCORE: _________________

SECTION / GROUP NO: _______________________ CONCEPT: _____________________________________
FACULTY: ___________________________________ DATE: ______________ ROOM NO: ______________

NUMERICAL
QUANTITATIVE DESCRIPTION
RATING
Carries out expected competency in a very consistent manner
4 Outstanding
with minimal guidance and supervision
Carries out expected competency in a moderately consistent
3 Very Good
manner with minimal guidance and supervision
Carries out expected competency in a rarely consistent manner
2 Satisfactory
with minimal guidance and supervision
Does not carry out expected competency even under close
1 Needs Improvement
guidance and supervision

Skills 4 3 2 1
Critical Performance Step
Step
BLS Survey and Interpretation
Check for responsiveness: Taps and shouts, "Are you alright, are you
ok?" Scan the chest for movements (5-10 secs.)
Tell someone to activate the Emergency Medical System and get an
AED.
Checks carotid pulse (min. 5 sec; Maximum 10 sees.)
Bares patient's chest and locate CPR hand position.
Delivers first cycle of compressions at correct rate (acceptable: 18
seconds or less for 30 compressions)
Give 2 breaths (1 second each)
AED Arrives
Turns AED on, Select proper pads, and place pads correctly.
Clear patient to analyze (must be visible and verbal check)
Clear patient to shock/presses shock button (must be visible and verbal
check; maximum time from AED arrival less than 45 secs.

Delivers second cycle of compressions at correct hand position

(acceptable greater than 23 to 30 compressions)
Gives two breaths (1 second each) with visible chest rise.
The next step is performed only if the manikin is equipped with a feedback
device, such as a clicker or light. If there is no feedback device, STOP THE TEST.
Delivers third cycle of compressions of adequate depth with complete
chest recoil (acceptable; greater than 23 compressions)

Score/Total Score X 100 = _________________

______________________________________ _________________________________________
Signature of Student Signature of Faculty