NAME: __________________________________ DATE: ___________________________

COURSE & SECTION: ______________________ INSTRUCTOR: _____________________

CHECKLIST IN HANDWASHING
INSTRUCTION: Check the column that correspond the performance in the given procedure.

PROCEDURE 4 3 2 1 0
Preparation & assessment
1. Prepare the materials to be used (tissue
and liquid soap) &
2. Assess the hands.
3. Remove all jewelries.
4. Check hands for break in the skin such as
hang nails or cuts.

PROCEDURE 4 3 2 1 0
HANDWASHING PROPER
1. Stand in front of the sink
2. Turn on water and adjust the flow. Do not
allow your uniform to touch the sink during
the washing procedure.
3. Flex slightly the knee if the sink is low.
4. Starting from the fingertips, wet until the
arm.
5. Pump an ample amount of liquid soap from
the dispenser/ lather thoroughly with bar
soap.
6. Rub hands palm to palm up to and including
the wrists.
7. Rub the back of both hands. Right palm
over back of the left with linked fingers and
vice versa
8. Palm to palm with fingers interlaced
together.
9. Interlock the fingers and rub the back of
fingers both sides.
10. Rotational rubbing of left thumb to left little
finger held in right palm and vice versa
11. Rub fingertips on palm for both hands
12. Rub both wrists in a rotational manner
13. Rinse hands well with water starting from
the fingertips to wrist.
14. Dry hands with a single use towel/tissue.
15. Use the towel/tissue to turn off the faucet.
TOTAL:
Remarks:
___________________________________________________________________________________________________________
___________________________________________________________.

Average: ____

Rating Scale:
4 - Very Extensively Performed
3 - Extensively Performed
2 - Fairly Performed
1 - Not Extensively Performed
0 - Not Performed

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