BLS Basic Life Support
Student Name: _________________________________________ Test Date: ________________________
Skills Checklist
Check if done
Adult/Child/ BLS - 1 and 2 Responders correctly
Steps Skills Demo
1- Responder Adult BLS Skills Evaluation
● Note: Evaluate the first rescuer’s ability to initiate BLS and deliver high-quality CPR for 5 cycles
1 Check for responsiveness
2 Call for help, activate the emergency response system and sends for an AED
Check for breathing and pulse for at least 5 seconds and no more than 10
3 seconds
4 Begin high-quality CPR
a. Correct compression Proper Hand Placement
i. Adult: Lower half of the breastbone, 2 hands
ii. Child: Lower half of the breastbone, 1 or 2 hands
b. Rate: Give 100 to 120/minute compressions or delivers each set of 30
Chest compressions in no less than 15 seconds and no more than 18
seconds
c. Depth: Deliver compression at least 2 inches in depth
d. Minimize interruptions: Gives 2 breaths with pocket mask in less than
10 seconds.
Second Rescuer AED Skills Evaluation and SWITCH
● Note: Evaluate the second rescuer’s ability to use the AED and both rescuers’ abilities to switch roles.
5 Instructor prompt: “After completing 5 cycles of compressions and breaths,
the AED arrives with bag mask device”.
6 Second Rescuer powers on AED and applies patches while first rescuer
continues CPR
a. Power AED on
b. Apply patches
i. Dry patient if wet
BLS Basic Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
ii. Do not use AED if patient on wet surface
iii. Remove any visible medication patches
iv. Do not apply patches over Pacemaker
v. Pediatric patches for child, if available
vi. Do not allow patches to touch or overlap
c. Second rescuer clear patient, allowing AED to analyze - Switch
rescuers
d. When AED prompts shockable rhythm, second rescuer clears the
patient again and delivers shock
e. Deliver Shock
f. Resume CPR starting with chest compressions
g. If AED states “No Shock Advised” resume CPR starting with chest
▢ PASS ▢ Needs Retest
Instructor Name: _________________________________________ Date: __________________
Check if done
Adult/Child/ BLS - 1 and 2 Responders correctly
Steps Skills Demo
First Rescuer Bag-Mask Ventilation
● Note: Evaluate the first rescuer’s ability to give breaths with a bag mask.
1 Both responders resume high-quality CPR immediately after shock delivery
2 Second responder gives 30 compressions immediately after shock delivery
for 2 cycles
3 First responder successfully delivers 2 breaths with bag-mask for 2 cycles
▢ PASS ▢ Needs Retest
Instructor Name: _________________________________________ Date: __________________
BLS Basic Life Support
Student Name: _________________________________________ Test Date: ________________________
Skills Checklist
Check if done
Infant BLS - 1 and 2 Responders correctly
Steps Skills Demo
1 Rescuer Infant BLS Skills Evaluation
● Note: Evaluate the first rescuer’s ability to initiate BLS and deliver high-quality CPR for 5 cycles
1 Check for responsiveness
2 Call for help, activate the emergency response system and sends for AED
Check breathing and pulse for at least 5 seconds and no more than 10
3 seconds
4 Deliver high-quality CPR
a. Correct compression: Proper Finger Placement
b. b. Rate: 100 to 120/minute compressions (each set of 30 compressions
in no less than 15 seconds and no more than 18 seconds
c. c. Depth: Deliver compression at least one third of the depth of the
chest (approximately 1 ½ inches or 4cm), at least 23 out of 30.
d. d. Allow complete chest recoil, at least 23 out of 30.
2 Rescuer CPR and SWITCH
● Evaluate the first responder’s ability to give breath with a bag-mask and give compressions by
using the 2 thumb-encircling hands technique.
● Evaluate both rescuers’ ability to switch roles
Instructor prompt: “After completing 5 cycles of compressions and breaths,
1 second responder arrives with bag mask device”.
2 a. Responders Switch Roles
3 Both responders resume high-quality CPR
a. Second responder delivers 15 compressions in no less than 7 seconds
and no more than 9 seconds by using thumb-encircling hands
technique for 2 cycles
BLS Basic Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
b. First responder successfully gives 2 breaths with bag-mask
for 2 cycles
After 2 Cycles, Prompt Responders to Switch Roles
4 Both responders resume high-quality CPR
a. First responder delivers 15 compressions in no less than 7 seconds
and no more than 9 seconds by using thumb-encircling hands
technique for 2 cycles
b. Second responder successfully gives 2 breaths with bag-mask for
2 cycles
▢ PASS ▢ Needs Retest
Instructor Name: _________________________________________ Date: __________________
