BLS​​Basic Life Support​

​Skills Checklist

Student Name:​_____________________________​Test Date:​________________________

Score:

5 – Significantly exceeds performance standards

4 – Exceeds performance standards

3 - Achieves performance standards

2 – Barely achieves performance standards

1 – Significantly below performance standards

5 4 3 2 1

1. Check for responsiveness

2. Call for help, activate the

emergency response system and
sends for an AED

3. Check for breathing and pulse for

at least 5 seconds and no more than
10 seconds

4. Begin high-quality CPR

 5. Correct compression Proper Hand
Placement
i. Adult: Lower half of the
breastbone, 2 hands
ii. Child: Lower half of the
breastbone, 1 or 2 hands

6. Rate: Give 100 to 120/minute

compressions or delivers each set of
30 Chest compressions in no less
than 15 seconds and no more than
18 seconds

7. Depth: Deliver compression at least

2 inches in depth

8. Minimize interruptions: Gives 2

breaths with pocket mask in less
than 10 seconds.

9. Correct positioning and body

posture and mechanics

10. Placed patient in recovery position

Clinical Instructor:

_________________________