Competency Performance Checklist

Assessing the Head & Neck

Student: Date: _____________

Element (HEAD) Yes Not Yet N/A

1. Introduced self and verified client’s identity.
2. Explained procedure to client and discussed how results will
be used.
3. Gathered appropriate equipment.
4. Performed hand hygiene and observed appropriate infection
prevention procedures.
5. Provided for client privacy.
6. Inquired about the client’s history related to head and neck.
7. Inspected the skull for size, shape, and symmetry.
8. Inspected the facial features.
9. Palpated for head consistency (masses and depression).
10. Palpated for temporal artery.
11. Palpated for Temporo-mandibular Joint (TMJ).
12. Noted symmetry of facial movements.
Element (NECK) Yes Not Yet N/A
13. Inspected the neck muscles for abnormal swellings or
masses. head movement. Asked client to:
14. Observed
a. Move the chin to the chest.
b. Move the head back so that the chin points upward.
c. Move the head so that the ear is moved toward the
shoulder.
d.on eachthe
Turn side.
head to the right and to the left.
15. Assessed muscle strength.
a. Asked the client to turn the head to one side against the
resistance of examiner’s
b. Shrugged hand. Repeated
the shoulders against thewith the other
resistance ofside.
examiner’s hands.
16. Palpated the entire neck for enlarged lymph nodes.
17. Palpated the trachea for lateral deviation.
18. Inspected and palpated the thyroid gland.
TOTAL
PERSONAL AND PROFESSIONAL ATTRIBUTES (10%) SCORE
1 2 3 4 5
1. Wears complete uniform & is well-groomed at all times.
2. Reports to his/her area of assignment on time.
3. Reports with complete prescribed duty uniform.
4. Performs assigned task on designated time.
5. Demonstrate compassion in the delivery of task.
6. Accepts criticisms constructively and makes appropriate changes.
7. Demonstrate good interpersonal relationship.
8. Demonstrates honesty and accountability.
9. Submits requirements on time.
10. Demonstrate effective time management.
11. Observes manners and courtesies at all times.
12. Follows the policies, procedures and guidelines of the course, department,
university and the affiliating agencies.
TOTAL

Comments:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Evaluated by: Acknowledged by:

______________________________ ____________________________
Name of Clinical Instructor Name and Signature of the student