Bag Technique (Performance Checklist)

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ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

BAG TECHNIQUE
(PERFORMANCE CHECKLIST)

Student’s Name: ________________________________ Score: _________________


Year & Sec: __________________________________Date Performed: _________________

Directions: Check Column “Yes” if identified behavior or skill is correctly demonstrated. Check
Column “No” if identified behavior or skill is not demonstrated or is incorrectly
demonstrated.

PROCEDURE YES N POINTS


O
1. Assess the completeness, neatness and availability of bag content and its 3
proper arrangement.
2. Determine the needs of the client on basis of findings during the home visit 3
3. Prepare all the equipment needed. 1
4. Upon arrival at the client’s home, place bag on a table or any flat surface 2
lined with paper lining.
5. Ask for basin of water. Place this outside the work area. ` 1
6. Open the bag. Take out the plastic lining and spread over the work field. 2
7. Take out the hand towel, soap dish and apron. Place them on one corner of 2
the work area.
8. Do hand washing. Wipe dry with hand towel. 1
9. Put on apron right side out and wrong side touching the body. 2
10. Take out things that will be mostly needed for a particular case and place in 2
one corner of the work field.
11. Place waste proper bag outside work area. 1
12. Close the bag. 1
13. Proceed to the specific nursing care treatment. 3
14. After completing nursing care or treatment, clean ad sanitize all equipments 2
used.
15. Do hand washing again. 1
16. Open the bag and put back all articles in their proper places. 2
17. Remove apron. 1
TOTAL 30

Remarks:______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Note: Refer to Transmutation Table for reference

Total Score:_____________
Total No. of Checked Yes:__________
Equivalent:_________________

Students Signature:__________________
Instructor’s Signature:_______________

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