Vital Signs Checklist

Pulse*

1. Wash Hands 2. Locate pulse and count rate for one full minute 3. Record results 4. Able to verbalize normal range

Employee Name:*

First Name

Last Name

Employee Signature:*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Instructor Signature:*

[clear]

Use your mouse or finger to draw your signature above

Respirations*

1. Wash Hands 2. Observe and count respirations for one full minute 3. Record results 4. Able to verbalize normal range

Employee Name:*

First Name

Last Name

Employee Signature:*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Instructor Signature:*

[clear]

Use your mouse or finger to draw your signature above

Temperature*

1. Wash Hands and put on gloves 2. Cleanse thermometer if necessary or use disposable protector 3. Place thermometer according to manufacturer's instructions and waits specified time 4. Removes thermometer and reads according to manufacturer's instructions. Removes gloves / wash hands 5. Records results including site: Otic (ear), Oral (mouth), Axillary (armpit) 6. Clean thermometer according to facility procedures

Employee Name:*

First Name

Last Name

Employee Signature:*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Instructor Signature:*

[clear]

Use your mouse or finger to draw your signature above

Blood Pressure*

1. Wash hands 2. Has client rest for 5 min before taking BP 3. Selects proper size cuff 4. Correctly wrap cuff around upper arm 5. Activates BP devise according to manufacturer's instructions 6. Clean thermometer according to facility procedures 7. Able to verbalize normal range

Employee Name:*

First Name

Last Name

Employee Signature:*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Instructor Signature:*

[clear]

Use your mouse or finger to draw your signature above

Health-Related Activities Skills Checklist: Vital Signs

Page 1