Information
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Document No.
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Sudent Name
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Client / Site
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Conducted on
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Prepared by
DRSABCD
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Does Student check for DANGER
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Does Student check for a RESPONSE
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Does Student Send for Help
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Does Student complete an Airway check / open
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On an adult
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On an infant
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Does Student do a Breathing- check
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Does Student Deliver CPR
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On an adult
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On an infant
Compressions
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Student shows Correct hand position
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Student demonstrates Correct depth for compressions
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Student completes a Continuous cycle of 30:2
Breaths
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Student displays Pistol grip, hand clear of throat
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Student completes Head tilt
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Student gets a Mouth seal
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Student Use second operator when available
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Student Calls for AED
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Completes Breaths within the cycle
Operate AED
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Student Operate AED according to instructions
Signs of life, aftercare
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Student Clear airway
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Student demonstrates the Recovery position
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Student Monitors the casualty
Declaration
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I declare that the information included in this report is true and I have witnessed the student participate in activities set out to simulate first aid
