RETURN DEMONSTRATION TOOL EVALUATION FOR:

Assessing the Hair

Name: _____________________________________ Grade: _____________
Time started:____________ Time ended:____________ Date of RD:________________________

AREA FOR EVALUATION RATING COMMENTS

SKILLS (35%) 5 4 3 2 1 0
ASSESSMENT /PLANNING
1. Check doctor’s order.
2. Assemble all equipments
needed.
 Clean gloves
IMPLEMENTATION
3. Identifies client.
4. Explains to the client what you are
going to do, why it is necessary,
and how he or she can cooperate.
5. Washes hands and observes
other appropriate infection control
procedures.
6. Provides for client’s privacy.
7. Determines client’s history of the
following:
 Recent use of hair dyes,
rinses, or curling or
straightening
preparations.
 Recent chemotherapy
 Presence of disease

8. Inspects the evenness of growth

over the scalp.
9. Inspects hair thickness or
thinness.
10. Inspects hair texture and oiliness.

11. Note presence of infections or

infestations by parting the hair in
several areas and checking
behind the ears and along the
hairline at the neck.
12. Inspects amount of body hair.
EVALUATION/DOCUMENTATION
1. Documents findings in the client’s
record.
KNOWLEDGE: (15%)
1. Gives rationale of the procedure.
2. Explains the elements and
 mechanics of the procedure.
3. Knows the elements of nursing
process as applied.
4. States principles applied in the
procedure.
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Clinical Instructor’s signature: ____________________________________