FOOTHILL COLLEGE

Candidate Name: _________________________________________ Date: ______________________

Examiner Name and Signature: _________________________________________________________

Time Started: __________ Time Ended: __________ Points: _____/11 PASS/FAIL (Circle One)

Points Possible Points Awarded
Student directs patient or assistant to manual stabilize the extremity 1
Exposes injured extremity 1
Removes jewelry from injured extremity if present 1
Assesses distal motor, sensory, and circulatory functions in the injured extremity 1
EXAMINER STATES: Motor, sensory, and circulatory functions are intact
Selects and Measures the splint 1
Applies the splint (Pad as approriate) 1
Immobilizes the joint above the injury site 1
Immobilizes the joint below the injury site 1
Secures the entire injured extremity 1
Immobilizes the hand/foot in the position of function 1
Reassesses distal motor, sensory, and circulatory functions in the injured extremity 1
EXAMINER STATES: Motor, sensory, and circulatory functions are intact

                                          Points possible: 11 Total Points Awarded___________

Critical Criteria

●      Did not immediately stabilize extremity manually

●      Grossly moves the injured extremity

●      Did not immobilize the bone above and below the injury site

●      Did not reassess distal motor, sensory, and circulatory functions in the injured extremity before and after splinting

●       Did not immobilize the hand or foot in a position of function

Notes: ____________________________________________________________________________________________

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