S.G.R.

D COLLEGE OF NURSING, PANDHER

TOPIC- CHECKLIST

SUBMITTED ON- 18/08/2020

SUBMITTED TO SUBMITTED BY
MRS. SONIA NANDA CHARANJIT KAUR

Associate professor M.sc {N}1st year

Signature of Student Signature of Evaluation

 S.G.R.D COLLEGE OF NURSING

Clinical Evaluation Performa

Course – BSC {N} 1ST YEAR
Name of Student Date-
Ward-
SR.NO CLINICAL COMPETENCIES YES NO
1 Identification of needs before planning procedure
2 Arrangement of tray and articles of the procedure
3 Explanation of procedure before starting the procedure
4 Privacy was maintained
5 Follows the steps of procedure
6 IPR was maintained during procedure
7 Sterile technique were used
8 Articles were replaced after procedure
9 Unit was maintained
10 Hand washing at the end
11 Recording and Reporting of procedure

Signature of Student Signature of Evaluation

Signature of Student Signature of Evaluation