DAVAO MEDICAL SCHOOL FOUNDATION

COLLEGE OF NURSING

PERFORMANCE CHECKLIST
LOGROLLING

Name: ___________________________________________________Date: _________________________________

Section:_________________________________________________ Rate: __________________________________

3 – CORRECTLY DONE 2 – INCORRECTLY DONE 1- NOT DONE

PROCEDURE 3 2 1
1. Check the chart. Check the identity of the patient.
2. Introduce yourself and explain the procedure. Assess patient’s ability
to assist in moving
3. Perform hand hygiene.
4. Raise the bed to a working height. Lower the head of the bed if the
patient can tolerate it. Lock the wheels of the bed
5. Lower the side rail on the side of the body at which you are working.
Position yourself with your feet apart and your knees flexed close to
the side of the bed.
6. With the assistance of another staff, place a draw sheet under the
patient’s back and head
7. The other nurse stands at the opposite side of the bed
8. The first nurse in the direction of the move holds the draw sheet
9. The second nurse supports the back of the patient towards the
direction of the move
10. The first nurse gives the signal to initiate the move by counting one,
two, three
11. Apply pillows at the patient’s back and in the abdomen
12. Assess for the patient's correct body alignment, comfort, and safety.
13. Lower the height of the bed. Raise the side rails and make sure that
the call light is within reach
TOTAL

FORM B: (30%) - _______________________

Performance: (70%) - _______________________
Final Grade: _______________________

________________________________ ________________
Student’s Printed Name and Signature Date

________________________________ ________________
Clinical Instructor’s Name and Signature Date