Emergency Oxygen Answer Sheet
Student Name
Instructor Name
Test Date
Instructor Number
Emergency Oxygen
Skills Checklist The Instructor will use this sheet to check off each skill as it is demonstrated successfully by the student. Skill Check 1: Attach Regulator and Use Nasal Cannula 1. Assess Environment and Equipment 2. Clear Cylinder Valve 3. Attach Pressure Regulator 4. Charge Pressure Regulator 5. Check Equipment 6. Use Nasal Cannula Skill Check 2: Prepare and Use Non-Rebreather Mask 1. Select Correct Size Mask 2. Connect Tubing & Select Liter Flow 3. Fill Oxygen Reservoir 4. Apply Mask Skill Check 3: Prepare Bag Mask for Use with Emergency Oxygen 1. Select Correct Size Bag Mask 2. Assemble Bag Mask 3. Connect Tubing & Select Liter Flow
Section Minimum Passing
Emergency Oxygen
Score
80% (16/20)
Student Score
____/20
Instructor Initials
Š2012 EMS Safety
Emergency Oxygen Administration
Version A