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GOVT.

COLLEGE OF NURSING, BILASPUR


(C.G.)
EVALUATION FORM FOR DEMONSTRATION
NAME……………………………………….CLASS……………………………
SUBJECT……………………………………DATE/TIME……………………….
TOPIC………………………………………NAME OF EVALUATOR……………………...
S.N. NURSING PROCEDURE TOTAL MARK MARK
ALLOTED
I PLANNING AND ORGANIZING

1. Preparation 06

2. Environment 02
3. Preparation of the patient 02

II EXECUTION OF PROCEDURE

1. Applies scientific principles 06

2. Proficiency in skill 06

3. Ensures sequential order 02

III TERMINATION OF PROCEDURE

1. Marks patient comfortable 02

2. Report and record 02

3. After care of procedure 02

TOTAL 30

REMARKS: SIGNATURE OF THE EVALUATOR……..

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