Nursing Procedure Checklist

Performing Bag Technique

Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill is not
performed correctly; and Not Done if the student failed to perform the skill.
Correctly Incorrectly Not
Procedure Done Done Done
1 .5 0
1. Greet the client/ family and introduce self.
2. State the purpose of home visit.
3. Observe the client/ family and determine the health needs 
4. Put the bag in a convenient place. Make sure place the bag on a table
or surface lined with clean paper. The clean side must be out and the
folded part is touching the table.
5. Ask for a basin of water or a glass of drinking water if tap water is not
available.
6. Open the bag and take out the towel and soap.
7. Wash hands using soap and water, wipe to dry.
8. Take out the apron from the bag and put it on with the right side out.
9. Put out all the necessary articles needed for the specific care.
10. Close the bag and put in one corner of the working area.
11. Proceed in performing the necessary nursing care and treatment.
12. After giving the treatment, clean all things that were used and
perform hand-washing.
13. Open the bag and return all things that were used in their proper
places after cleaning them.
14. Remove apron folding it away from the person, the soiled side in and
place it in bag.
15. Fold the lining, place it inside the bag and close the bag.
16. Take the record and write down all the necessary data that were
gathered and observed, the nursing care and treatment rendered
17. Talk to the client/ family/ significant other and give instructions for
care to the involved client (patient) in the absence of the nurse.
18. Make an appointment for the next visit (either home visit or clinic
visit) taking note of the date and time.

Comment:
_________________________________________________________________________________________
_____________________________________________ __________________

Score: ____/18___

Name of Student: Date Performed:                          

(Signature over Printed Name)

Evaluated by:                                                             Date of Evaluation:                      

(Signature Over Printed Name)