Evaluation Tool for Giving Measles Vaccine

Name: Date:
Year Level and Section: Course:

Criterion 4 3 2 1
A. Attitude
1. Wears complete prescribed uniform
2. Neat and well groomed.
3. Observes proper decorum.
4. Demonstrates initiative to learn.
5. Acknowledges criticisms and suggestions. 
B. Knowledge Competencies
1. States objective of the activity.
2. Explains rationale of steps.
3. Uses appropriate terms.
4. Speaks in client’s level of understanding. 
C. Skill Competency 
1. Ask the mother to hold the child firmly..
2. Clean the skin with cotton ball moistened with water and let skin
dry.
3. With the fingers of onbe hand, pinch up the skin on the outer side
of the upper arm.
4. Without touching the needle ibnto the pinched up skin so that it is
not pointing.
5. Slightly pull the plunger back before injecting to be sure that the
vaccine is not injected into the vein (if using disposable syringes and
needles.)
6. Press the plunger gently and inject.
Total

Rate the student from 1 to 4 where:

4 is very satisfactory: exhibits competency very satisfactorily

3 is satisfactory: exhibits competency satisfactorily
2 is fair: exhibit competency fairly
1 is needs improvement: needs to improve

Raw Score
Grade Percentage= --------------------------- x 60+40
60

____________________
Student’s Signature

____________________
Evaluator

las/conm