Far Eastern University

Institute of Health Sciences and Nursing

Department of Nursing

PERFORMANCE EVALUATION TOOL FOR

TRANSFERRING (One / Two Man Carry, Fireman/Blanket/Shoulder Drag)

NAME: ____________________________________________ SCORE: ________________

SEC & GRP NO: ________________ CONCEPT: _________________________________

( ) One Man Carry ( ) Two Man Carry ( ) Fireman’s Drag ( ) Blanket Drag ( ) Shoulder Drag

DIRECTION: Rate the Learner based on the expected procedure/behavior listed below.

RATING DESCRIPTION
2 Acceptable Demonstrate expected procedure / behavior correctly.
1 Moderately Acceptable Demonstrate expected procedure / behavior with minimal error.
0 Unacceptable Missed procedure or procedure done but entirely incorrect.

Step Critical Performance Step Rating Remarks

1 Declared that the” Scene is safe” 0 1 2
2 Kneel on the victim’s side. 0 1 2
Crawl on the victim’s side. (Fireman’s Drag)
3 Position of the victim’s arms. 0 1 2
4 Bend the victim’s knee and support with your non-dominant hand or 0 1 2
foot.
Support the victim’s wrist with bandage. (Fireman’s Drag)
Turn the patient body on right or left side. (Blanket Drag)
5 0 1 2
Support the victims back of the head by placing your dominant hand.
Position your body and your shoulder under the victim’s wrist. (Fireman’s
Drag)
Insert the blanket. (Blanket Drag)
6 Support the victim’s back with your knee. 0 1 2

Stabilize your knees and your hands on the floor. (Fireman’s Drag)
Turn the patient’s body on supine position. (Blanket Drag)
7 Hold the victim’s elbow (opposite sex). Insert your hands on the victim’s 0 1 2
armpit and lock his wrists with your hands (same sex)

Check the floor for safe transport. (Fireman’s Drag)

Fold or Square knot the two upper end of the blanket. (Blanket Drag)
8 Proper command to stand/to sit down. 0 1 2

Transfer the victim on the safe place. (Fireman’s Drag)

Before the transport; check the floor surface for safety by sweeping your non
dominant foot before dragging the victim’s body. (Shoulder Drag) (Blanket
Drag)
9 Observes proper carrying/transferring of the victim while observing 0 1 2
correct body mechanics (1 man / 2man carry)

Remove the wrist bandage. (Fireman’s Drag)

10 Observes proper unloading of the victim. 0 1 2

Proper position of the victim after the transport. (Fireman’s Drag)

Grade: Raw Score ___/ 20 X 100 = ________

_________________________________ ____________________________________
Signature of Student Name & Signature of Faculty
 Far Eastern University
Institute of Health Sciences and Nursing
Department of Nursing

PERFORMANCE EVALUATION TOOL FOR

TRANSFERRING (4-8 Man Carry: Bearer’s Along Side/ Hammock)

NAME: ____________________________________________ SCORE: ________________

SEC & GRP NO: ________________ CONCEPT: _________________________________

( ) Bearer’s Along Side ( ) Hammock

DIRECTION: Rate the Learner based on the expected procedure/behavior listed below.

RATING DESCRIPTION
2 Acceptable Demonstrate expected procedure / behavior correctly.
1 Moderately Acceptable Demonstrate expected procedure / behavior with minimal error.
0 Unacceptable Missed procedure or procedure done but entirely incorrect.

Step Critical Performance Step Remarks

1 Declared that the” Scene is safe” 0 1 2
2 Find the height of the rescuer (tallest rescuer position at the victim’s 0 1 2
head) Kneel on the victim’s side. (Bearer’s Along Side)

Find the height of the rescuer (tallest rescuer position at the victim’s
head), half of the rescuers go to the opposite side and Kneel on the
victim’s side. (Hammock)
3 Position of the victim’s arms. 0 1 2
4 Show the rescuers’ hands to support the victim’s back. (Sizing up) 0 1 2
(Bearer’s Along Side)

Show the rescuers’ hands to support the victim’s back, Practice interlock,
and unlock. (Sizing up) (Hammock)
5 Insert the hands at the back to support the victim’s lower extremities, 0 1 2
back, and back of the head. (Bearer’s Along Side)

Insert the hands at the victim’s back. (Hammock)

6 Lift the victim on the rescuers’ lap. (Bearer’s Along Side) 0 1 2

Lock the hands of the rescuers to support the victim’s lower extremities,
back, and back of the head. (Hammock)
7 Clip the victim on the rescuers’ chest. (Bearer’s Along Side) 0 1 2

Lift the victim on the rescuers’ lap. (Hammock)

8 Proper command to stand/to sit down. 0 1 2
9 Observes proper carrying/transferring of the victim while observing 0 1 2
the proper body mechanics.
10 Observes proper unloading of the victim. 0 1 2

Grade: Raw Score ___/ 20 X 100 = ________

_________________________________ ____________________________________
Signature of Student Name & Signature of Faculty