Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Objective Structured Clinical Examination

Practicum site: Laboratory Demonstration
Task Name: Routine Hand washing. Station No: _______1_____
Situation:
Assume you were assigned in sample collection section of your laboratory and you have been working in this
section. You collected a blood sample from the patient. Now it is time for lunch and you are going to leave
the room for lunch. Thus, before leaving the room, you have to wash your hands for infection prevention.
Directions to assessors:
 Observe and interview if the participant is performing the steps of routine hand washing in their
correct sequence (as necessary) in compliance with routine hand washing procedures
 interview the participant about the importance and when to perform routine hand washing
 score 1 if the step is performed, score 0 if the step is not performed
 Method/s of Assessment:
o Observation and Oral interview
Directions to students
 Perform routine handwashing according to the hand washing procedures/guidelines
 The task should be completed within two minutes
Supplies and materials:
 Plain or antimicrobial soap
 Tap water
 Single use towel(optional)
 Assessment tools
Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder

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 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I
Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration

Checklist for performing routine hand washing

No Steps Score Remark/s
(1/0)
1 Wet hands with tape water
2 Apply enough soap to cover all hand surfaces
3 Rub hands palm to palm
4 Right palm over left dorsum with interlaced fingers and vice versa
5 Palm to palm with fingers interlaced
6 Backs of fingers to opposing palms with fingers interlocked
7 Rotational rubbing of left thumb clasped in right palm and vice versa
8 Rotational rubbing, backwards and forwards with clasped fingers of right
hand in left palm and vice versa
9 Rinse hands with water
10 Dry hands thoroughly with a single use towel;
11 Use towel to turn off faucet;
12 Allow hands to air dry by holding up hands away from other bodies parts
or use personal single towel to dry hands
Score 1 if the step is performed; score 0 if the step is skipped

Pass Score: ___________

Student Score: ___________
Participant status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

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Debre Birhan Health Science College Performance Assessment for MLT Students Year: I
Objective Structured Clinical Examination
Practicum site: Laboratory Demonstration
Task Name: Hand Rub. Station No: _______1________
Situation:
In your laboratory, you performed a urine microscopy and reported your patient results. After the completion
of your task you want to perform routine hand washing but unfortunately there is no tape water in your
laboratory. So you have to use alternate methods for hand hygiene before going to the next task.
Directions to assessors:
 Observe and interview if the participant is performing the steps of routine hand washing in their
correct sequence (as necessary) in compliance with routine hand washing procedures
 interview the participant about the importance and when to perform routine hand washing
 score 1 if the step is performed, score 0 if the step is not performed
 Method/s of Assessment:
o Observation and Oral interview
Directions for students
 Perform hand rub according to the hand washing procedures/guidelines
 The task should be completed within 1 minute
Supplies and materials:
 Alcohol based sanitizer
 Assessment tools
Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder

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 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration

Checklist for performing hand rub

No Steps Score Remark/s
(1/0)
1 Apply a palm full of the alcohol/sanitizer in a cupped hand, covering all
surfaces
2 Rub hands palm to palm
3 Right palm over left dorsum with interlaced fingers and vice versa
4 Palm to palm with fingers interlaced
5 Backs of fingers to opposing palms with fingers interlocked
6 Rotational rubbing of left thumb clasped in right palm and vice versa
7 Rotational rubbing, backwards and forwards with clasped fingers of right
hand in left palm and vice versa
8 Allow hands to air dry by holding up hands away from other bodies parts
Score 1 if the step is performed; score 0 if the step is skipped

Pass Score ___6/8(75%) ________

Student Score: ___________
Participant status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

Objective Structured Clinical Examination OHS Page 4 of 16

Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Objective Structured Clinical Examination

Practicum site: Lab. Demonstration
Task Name: Putting on a Sterile Glove. Station No: _______2___________
Situation:
In your laboratory, you sterilized microbiological instruments used for culture media preparation. After you
complete your sterilization procedure, you are going to put out the instruments for use. To do this, you need
to wear sterile glove to prevent the instrument from being contaminated by transient microorganism from
your hands.
Directions to assessors:
 Observe if the participant is performing the steps of donning of gloves in their correct sequence (as
necessary) in compliance with donning procedures
 interview the participant about the importance of hand hygiene in microbiological tests procedure
 score 1 if the step is performed, score 0 if the step is not performed
 Method/s of Assessment:
o Observation and Oral interview
Directions for students
 Put on a sterile glove according to the procedures/guidelines
 The task should be completed within 1 minute
Supplies and materials:
 Sterile glove
 Alcohol based sanitizer
 Assessment tools
Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder

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 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I
Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration
Assessment checklist for putting on sterile glove
No Steps Score Remark/s
(1/0)
1 Perform hand hygiene and completely dry it
2 Open the sterile gloves on a dry, flat, clean work surface
3 Remove the outer package by separating and peeling apart the sides of the
package.
4 Grasp the inner package and lay it on a clean, dry, flat surface at waist level.
5 Open the top flap away from your body; open the bottom flap toward your body
6 Open the side flaps without contaminating the inside of the wrapper or allowing it
to close
7 Using only thumb and index finger, grasp the folded cuff edge of the glove
8 Slip the hand into the glove
9 Pick up 2nd glove by sliding gloved hand under the cuff of the glove.
10 In a single movement, slip the 2nd glove onto the ungloved hand. Do not touch
any other surface.
11 Adjust the fingers and interdigital spaces.
12 Unfold the first cuff by gently slipping the fingers of the other hand inside the
fold.
13 The hands are gloved and must only touch sterile devices or the previously
disinfected patient body area.
Score 1 if the step is performed; score 0 if the step is skipped

Pass Score ___________

Student Score: ___________
Student status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

Objective Structured Clinical Examination OHS Page 6 of 16

Debre Birhan Health Science College Performance Assessment for MLT Students Year: I
Objective Structured Clinical Examination
Practicum site: Lab. Demonstration
Task Name: Putting off a Sterile Glove. Station No: _______2___________
Situation:
In your laboratory, you collected cluttered wastes on the floor of the room which were contaminated with
blood sample. To collect these wastes you used a gloved hand.
Directions to assessors:
 Observe if the participant is performing the steps of doffing of a glove in their correct sequence (as
necessary) in compliance with doffing procedures
 interview the participant about the importance of hand hygiene
 score 1 if the step is performed, score 0 if the step is not performed
 Method/s of Assessment:
o Observation and Oral interview
Directions for students
 Put off a sterile glove according to the procedures/guidelines
 The task should be completed within 1 minute
Supplies and materials:
 Surgical Glove
 Alcohol based sanitizer
 Tape water
 Plain or antimicrobial soap
Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder

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 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration

Assessment checklist for doffing of contaminated glove

No Steps Score Remark/s
(1/0)
1 Grasp the outside edge of one cuff with gloved hands, avoid touching the wrist.
Pull the glove off, turning it inside out and place it in your hand.
2 Hold the removed glove in your gloved hand.
3 Slide an ungloved finder or thumb under the cuff of the remaining glove.
4 Peel the glove off inside out over the previously removed glove, bagging both
gloves
5 Discard the gloves.
6 Perform hand hygiene after glove removal.
Score 1 if the step is performed; score 0 if the step is skipped

Pass Score ___________

Student Score: ___________
Student status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

Objective Structured Clinical Examination OHS Page 8 of 16

Debre Birhan Health Science College Performance Assessment for MLT Students Year: I
Objective Structured Clinical Examination
Practicum site: Lab. Demonstration
Task Name: Identification and using of different safety PPEs. Station No: _______2______
Situation:
You are provided a list of safety equipments (personal protective equipments) in the laboratory
demonstration room.
Directions to assessors:
 Observe if the participant is correctly identifying and naming of all the provided PPEs according to
the list provided
 interview the participant about the use of every safety equipment
 score 1 if he/she correctly identified and explain its use, score 0.25 if s/he correctly identified but
not explained its use, score 0 if s/he not identified and explained correctly
 Method/s of Assessment:
o Observation and Oral interview
Directions for students
 Identify and name all provided PPEs according to the list you are provided
 Explain the use of all provided PPEs
 Show how to use every safety equipment
 The task should be completed within 10 minutes
Supplies and materials:
 Clean glove  Apron  Head cover
 Surgical glove  Eye google  Surgical mask
 Elbow length glove  Face shield  N95 mask
 Gown  Shoe cover

Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder

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 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration

Assessment checklist for identification and use of laboratory PPEs

No Steps Score Remark/s
(0/0.25/1)
1 Identify and Name the safety equipment
 Gown (disposable, reusable)
 Apron
 Face shield
 Aye google
 Glove(clean, Surgical, Utility)
 Show over
 Mask (face, N95)
 Head cover
2 Explain the use of every equipment
3 Prepare safety equipment for use
4 Show how to apply the equipment for safety

score 1 if he/she correctly identified and explain its use, score 0.25 if s/he correctly identified but not explained its
use, score 0 if s/he not identified and explained correctly

Pass Score ____3/4(75%)_______

Student Score: ___________
Student status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

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Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Objective Structured Clinical Examination

Practicum site: DBCSHL
Task Name: Identification and use of laboratory safety equipments Station No: __-_____
Situation:
You are provided a list of safety equipments in the laboratory demonstration room.
Directions to assessors:
 Observe if the participant is correctly identifying and naming of all the provided PPEs according to
the list provided
 interview the participant about the use of every safety equipment
 score 1 if he/she correctly identified and explain its use, score 0.25 if s/he correctly identified but
not explained its use, score 0 if s/he not identified and explained correctly
 Method/s of Assessment:
o Observation and Oral interview
Directions for students
 Identify and name all provided PPEs according to the list you are provided
 Explain the use of all provided PPEs
 Show how to use every safety equipment
 The task should be completed within 10 minutes
Equipment and materials:
 Biohazard bag  BSC  Steam sterilizer
 Emergency shower  Emergency evacuation  Dry oven
 Eye wash station  Fire extinguisher

Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder
Objective Structured Clinical Examination OHS Page 11 of 16
 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration

Equipment Name_________________________________________

Assessment checklist for identification and use of laboratory safety equipment

No Steps Score Remark/s
(0/0.25/1)
1 Identify and explain the use of the safety equipment
2 Identify and explain different components of safety equipment
3 Prepare safety equipment for use
4 Apply the equipment for safety
5
score 1 if he/she correctly identified and explain its use, score 0.25 if s/he correctly identified but not explained its
use, score 0 if s/he not identified and explained correctly

Pass Score ___________

Student Score: ___________
Student status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

Objective Structured Clinical Examination OHS Page 12 of 16

Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Objective Structured Clinical Examination

Practicum site: Laboratory Demonstration
Task Name: Preparing disinfectant solutions. Station No: _______1_____
Situation:
In your laboratory, the safety officer orders you to prepare one litter of 0.5% diluted bleach solution from 5%
stock solution.
Directions to assessors:
 Observe and interview if the participant is performing the steps of solution preparation in their
correct sequence (as necessary) in compliance with routine hand washing procedures
 interview the participant about the importance of the disinfectant
 score 1 if the step is performed, score 0 if the step is not performed
 Method/s of Assessment:
o Observation and Oral interview
Directions to students
 Prepare one liter of 0.5% diluted bleach solution from 5% stock solution according to the solution
preparation procedures/guidelines
 The task should be completed within 10 minutes
 Label and store the prepared solution
Supplies and materials:
 Glove  5% Stock bleach solution
 Tap water  Calculator (if applicable)
 Graduated or measuring  Assessment tools
cylinder
Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result

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 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder

Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration

Checklist for preparing disinfectants

No Steps Score Remark/s
(1/0)
1 Calculate the correct volume of the solvent(water) to be added
2 Calculate the correct volume of the solute (stock bleach) to be added
3 Measure the calculated volume of the solvent correctly by considering the
meniscus of the liquid
4 Measure the calculated volume of the solute correctly by considering the
meniscus of the liquid
5 Mix thoroughly the solvent(water) and the solute(stock bleach)
6 Label the expiry date of the working solution
7 Label the concentration of the working solution
8 Label the name of the working solution
9 Store the working solution in a recommended container and place
10 Explain when and how to use the solution
11
12
Score 1 if the step is performed; score 0 if the step is skipped

Pass Score: ___________

Student Score: ___________
Participant status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

Objective Structured Clinical Examination OHS Page 14 of 16

Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Objective Structured Clinical Examination

Practicum site: Laboratory Demonstration
Task Name: Donning ad Doffing sequence of PPEs Station No: _______1_____
Situation:
You are provided a list of personal protective equipment in the laboratory demonstration room.
Directions to assessors:
 Observe and interview if the participant is performing the steps of PPE donning and doffing in their
correct sequence (as necessary) according to the guidelines
 interview the participant about the importance of keeping order of PPE donning and doffing
 score 1 if the step is performed, score 0 if the step is not performed
 Method/s of Assessment:
o Observation and Oral interview
Directions to students
 Put on the provided PPEs according to the order of donning guidelines
 Put off the provided PPEs according to the order of doffing guidelines
 The task should be completed within 10 minutes
Supplies and materials:
 Clean/Surgical glove  Eye google  Head cover
 Gown  Face shield  Mask
 Apron  Shoe cover
N95 mask Note:
 Assessors have a responsibility to notify evaluation result at the end of evaluation to the students
 Every student has the right to observe their results that are given by each assessor and put their sign
on the evaluation form.
 The student may or may not agree on their result but they must put their signature to assure they
observe their evaluation result
 The laboratory assistant should receive and keep all student’s assessment checklist in the
folder/binder

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 Debre Birhan Health Science College Performance Assessment for MLT Students Year: I

Student’s Name: ___________________________ID No_________Practicum site: Lab. Demonstration

Checklist for donning and doffing sequence of PPEs

No Steps Score (1/0) Remark/s
Donning sequence of PPEs
1 Put on foot wears
2 Put on gown
3 Put on mask (surgical or any type of mask)
4 Put on eye google or face shield
5 Put on head cover
6 Perform hand hygiene
7 Put on glove
8 Put on apron
Sub total
Doffing sequence of PPEs
1 Put off shoe cover
2 Remove glove
3 Remove apron
4 Remove gown
5 Perform hand hygiene
6 Remove eye protection (eye google, face shield)
7 Remove mask (face, surgical any type of mask)
8 Perform hand hygiene
Score 1 if the step is performed; score 0 if the step is skipped

Pass Score: ___6/8(75%) ________

Student Score: ___________
Participant status: Pass Fail
Supervisor name: _______________________________ Signature: ______________Date: ______________
Name of the student:–––––––––––––––––––––––––––– Signature: _______________Date: _____________

Objective Structured Clinical Examination OHS Page 16 of 16