Evaluation Tool for Giving BCG Vaccine

Name: Date:
Year Level and Section: Course:

Criterion 4 3 2 1
A. Attitude
1. Wears complete prescribed uniform
2. Neat and well groomed.
3. Observes proper decorum.
4. Demonstrates initiative to learn.
5. Acknowledges criticisms and suggestions. 
B. Knowledge Competencies
1. States objective of the activity.
2. Explains rationale of steps.
3. Uses appropriate terms.
4. Speaks in client’s level of understanding. 
C. Skill Competency 
1, Clean the skin with cotton ball moistened with water and let skibn
dry.
2. Hold the child’s arm with left hand so that: your hand is under the
arm, and your thumb and fingers come around the arm and stretch the
skin.
3. Hold the syringe with your right hand with the bevel and the scale
pointing up towards you.
4. Lay the syringe and needle almost that along the child’s arm.
5. Insert the tip of the needle into skin – just the bevel and a little bit
more. Keep the needle flat along the skin and the bevel facing
upwards, so that the vaccine only goes into the layers of the skin.
6. Put your left thumb over the needle end of the syringe to hold it I
position. Hold the plunger end of the syringe between the index and
middle fingers of your right hand and press the plunger in with your
right thumb.
7. If the vaccine is injected correctly into the skin, a flat wheal with
the surface pitted like an orange peel will appear on the injection site.
8. Withdraw the needle gently.
Total

Rate the student from 1 to 4 where:

4 is very satisfactory: exhibits competency very satisfactorily

3 is satisfactory: exhibits competency satisfactorily
2 is fair: exhibit competency fairly
1 is needs improvement: needs to improve

Raw Score
Grade Percentage= --------------------------- x 60+40
68

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Student’s Signature

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Evaluator

las/conm