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: ____________________________________________________________________________________________
__________________________________________________________________________________________________