Name of Student: _________________________________Year/Section/Group: _________Score:________

Able to Able to Unable REMARKS

perform perform to
CPR/RB – Child, Infant (2 pts) with perform
assistance (0 pt)
(1 pt)
1. Survey the scene – “The scene is safe. I found a patient lying on
the floor presumed unconscious.”
2. Ask consent – “Give way 2x, I am _______, a trained CPR
provider, I can help.”
3. Check consciousness
- Tap shoulders twice (children)
“Hey Hey, are you okay?”
-Tap sole of the feet twice (infants)
“ Baby, baby are you okay”
4. ***if client is unconscious – Activate Medical Assistance –
“Activate Medical Assistance and Transport Facility and report back
to me while I assess and help the patient.”
5. Check for circulation – check pulse for 10 secods
6. Open Airway – Head Tilt-Chin Lift Maneuver
7. Check Airway –Look for presence of obstruction
8. ***if no visible object – Check for Breathing –
Do Look Listen Feel (LLF) for 10 seconds
9. If with pulse but without breathing – do Rescue Breathing (RB)
For Child (40 breaths per 2 minutes)
For infant (40 breaths per 2 minutes)
10. ***if breathless - give 2 initial ventilations
11. 1st ventilation – air goes in – give 2nd ventilation
2nd ventilation – air goes in – check pulse for 10 seconds
12. If without pulse, without breathing – do Cardio Pulmonary
Resuscitation (CPR)
For Child (30 compressions:2 ventilations)
For infant (30 compressions:2 ventilations) for 5 cycles
13. Check for circulation – check pulse for 10 seconds
14. No pulse, no breathing – give CPR
No breathing, has pulse – give RB
15. With pulse, with breathing – Recovery position
Child – side lying
Infant - cuddle
TOTAL SCORE (30)

Note: Continue CPR until emergency response providers arrive or the infant begins to move.