Checklist For Adult:

Skill Tested	Completed
	Yes	No
Establish scene safety
Assess patient responsiveness (check for pulse/breathing, no longer than 10 sec)
Activates emergency response (calls for help/AED)
Correct CPR hand placement and positioning
Correct CPR rate (100-120/min.) and depth (2 inches)
Allows for complete recoil of chest between compressions
Airway opened appropriately (head tilt/chin lift, jaw thrust)
Delivers 2 breaths (each over 1 second) with visible chest rise
Correct AED placement without disrupting compressions
Clear of patient for rhythm analysis and shock
Compressions immediately resumed after shock

Checklist For Child:

Skill Tested	Completed
	Yes	No
Establish Scene Safety
Assess Child Responsiveness (Check for pulse/breathing, no longer than 10 sec)
Activates Emergency Response (Calls for help/AED)
Correct Child CPR Hand Placement and Positioning
Correct Child CPR Rate (100-120/min.) and Depth (2 inches)
Allows for Complete Recoil of Chest Between Compressions
Airway Opened Appropriately for Child (Head tilt/Chin lift, Jaw thrust)
Delivers 2 Breaths (Each over 1 second) with Visible Chest Rise
Correct AED Placement Without Disrupting Compressions
Clear of Patient for Rhythm Analysis and Shock
Compressions Immediately Resumed After Shock

Checklist For Infant:

Skill Tested	Completed
	Yes	No
Establish Scene Safety
Assess Infant Responsiveness (Check for pulse/breathing, no longer than 10 sec)
Pulse Check (Brachial artery location, inner part of the upper arm)
Activates Emergency Response (Calls for help/AED)
Correct Infant CPR Hand Placement and Positioning
Correct Infant CPR Rate (100-120/min.) and Depth (About 1.5 inches)
Allows for Complete Recoil of Chest Between Compressions
Airway Opened Appropriately for Infant (Head tilt/Chin lift, Jaw thrust)
Delivers 2 Breaths (Each over 1 second) with Visible Chest Rise
Correct AED Placement Without Disrupting Compressions (If applicable, use of infant/child pads)
Clear of Patient for Rhythm Analysis and Shock
Compressions Immediately Resumed After Shock

Instructor ACLS Skills Verification: A Checklist by American Academy of CPR and First Aid

Skill Tested	Completed
	Yes	No
Assigns roles
Ensures high quality CPR (rate, depth, recoil, ventilation)
Demonstrates good communication

Primary assessment:

Skill Tested	Completed
	Yes	No
Places monitor leads properly
Recognizes hypoxemia and administers oxygen
Places intravenous access

Bradycardia:

Skill Tested	Completed
	Yes	No
Identifies symptomatic bradycardia
Assesses for other underlying causes
Determines the presence of hypotension or shock symptoms
Administers correct dose of atropine (1mg, q 3-5 minutes)
Prepares for transcutaneous pacing

Ventricular fibrillation:

Skill Tested	Completed
	Yes	No
Identifies ventricular fibrillation
Clears the patient before analysis and shock
Resumes CPR immediately after shock
Administers epinephrine 1mg q3-5 minutes
Demonstrates appropriate drug, shock and CPR cycles
Advanced airway is placed with capnography

Post Cardiac Arrest Care:

Skill Tested	Completed
	Yes	No
Identifies ROSC
Optimizes oxygenation (>94%) and ventilation (10 breaths/min)
Obtains a blood pressure
12-lead ECG
Considers targeted temperature management