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Christ the King College

College of Nursing
Calbayog City

Name: ___________________________ Year/Sec _____________ Score: _______

PERFORMANCE CHECKLIST:
HANDWASHING

PERFORMANCE POINTS WEIGHT SCORE REMARKS


1. Wet hands with water 3

2. Apply single shot of soap 3

3. Rub hands palm to palm 5

4. Rub back of each hand with the palm 5


of other the hand with fingers
interlaced

5. Rub palm to palm with fingers 5


interlaced

6. Rub with backs of fingers to opposing 5


palms with fingers interlocked

7. Rub each thumb clasped in opposite 5


hand using rotational movement

8. Rub tips of fingers in opposite palm in 5


circular motion

9. Rub each wrist with opposite hand 5

10. Rinse hands with water 3

11. Dry thoroughly 3

Source: WHO

REMARKS:

EVALUATOR:

(Signature over Printed Name)

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