Child CPR Skills Testing Checklist
Student Name _____________________________________ Date of Test ______________
Scenario: “You are home alone with a child, and the child suddenly collapses in front of you.
The scene is safe and you have a cell phone with you, but no AED nearby. Demonstrate what you
would do next.”
Check if done
Assessment and Activation correctly
1 Checks responsiveness
2 Shouts for help/Phones 9-1-1 on cell phone
3 Checks breathing
Cycle 1 of CPR (30:2) *CPR feedback devices preferred for accuracy
Child Compressions
Performs high-quality compressions*:
• Hand placement on lower half of breastbone
1 • 30 compressions in no less than 15 and no more than 18 seconds
• Compresses at least one third the depth of the chest,
about 2 inches (5 cm)
• Complete recoil after each compression
Child Breaths
Gives 2 breaths with a barrier device:
2 • Each breath given over 1 second
• Visible chest rise with each breath
• Gives 2 breaths in less than 10 seconds
Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed
1 Gives 30 high-quality compressions
2 Gives 2 effective breaths
Cycle 3 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed
1 Gives 30 high-quality compressions
2 Gives 2 effective breaths
Instructor says, “EMS has arrived and is taking over.”
Child CPR Skills Testing Checklist
STOP TEST
Instructor Notes
• Place a in the box next to each step the student completes successfully.
• If the student does not complete all steps successfully (as indicated by at least 1 blank
check box), the student must receive remediation. Make a note here of which skills require
remediation (refer to Instructor Manual for information about remediation).
Test Results Check PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials ___________________ Instructor Number ___________________ Date _____________
Skills Testing Critical Skills Descriptors
Assesses victim and activates emergency response system (this must precede
starting compressions) within a maximum of 30 seconds. After determining that
the scene is safe:
• Checks for responsiveness by tapping and shouting
1
• Shouts for help and phones 9-1-1
• Checks for no breathing or no normal breathing (only gasping)
–– Scans from the head to the chest for a minimum of 5 seconds and no more
than 10 seconds
Cycle 1: Performs high-quality chest compressions (initiates compressions
immediately after recognition of cardiac arrest)
• Correct hand placement
–– Lower half of breastbone
–– 1- or 2-handed (second hand on top of the first)
2 • Compression rate of 100 to 120/min
–– Delivers 30 compressions in 15 to 18 seconds
• Compression depth and recoil—compress at least one third the depth of the
chest, about 2 inches (5 cm)
–– Use of a commercial feedback device/manikin is highly recommended
–– Complete chest recoil after each compression
Child CPR Skills Testing Checklist
Skills Testing Critical Skills Descriptors
Cycle 1: Provides 2 breaths by using a barrier device
• Opens airway adequately
–– Uses a head tilt–chin lift maneuver
3 • Delivers each breath over 1 second
• Delivers breaths that produce visible chest rise
• Avoids excessive ventilation
• Resumes chest compressions in less than 10 seconds
4 Cycle 2: Performs same steps for compressions and breaths as in Cycle 1
5 Cycle 3: Performs same steps for compressions and breaths as in Cycle 1
