ACLS Course―2015 Interim Tool
CPR and AED Skills Test
1-Rescuer Adult CPR and AED Checklist
Student Name: Test Date:
Skill ✓ if done
Critical Performance Steps correctly
Step
BLS Survey and Interventions
1 Checks for responsiveness: Taps and shouts, “Are you all right?”
2 Yells for help, activates the emergency response system, and sends for an AED
3 Checks breathing and pulse (breathing and pulse check can be performed simultaneously;
minimum 5 seconds, maximum 10 seconds)
4 Bares patient’s chest and locates CPR hand position
5 Delivers first cycle of compressions at correct rate: 100 to 120/min (delivers 30 chest
compressions in no less than 15 and no more than 18 seconds)
6 Gives 2 breaths (1 second each)
AED Arrives
AED Turns AED on, selects proper pads, and places pads correctly
1
AED Clears patient to analyze (must be visible and verbal check)
2
AED Clears patient to shock/presses shock button (must be visible and verbal check;
3 maximum time from AED arrival less than 45 seconds)
Student Continues CPR
7 Delivers second cycle of compressions at correct hand position (acceptable: greater
than 23 of 30 compressions)
8 Gives 2 breaths (1 second each) with visible chest rise
The next step is performed only if the manikin is equipped with a feedback device, such as a clicker or light. If there is
no feedback device, STOP THE TEST.
9 Delivers third cycle of compressions of adequate depth with complete chest recoil
(acceptable: greater than 23 compressions)
STOP TEST
Test Results Circle P or NR to Indicate Pass or Needs Remediation: P NR
Instructor signature affirms that skills Instructor Signature:
tests were done according to AHA
Guidelines. Print Instructor Name:
Save this sheet with course record. Date: