Name : Date:
CHECKLIST FOR BAG TECHNIQUE
ATTEMPT
S.no. Content 1 2 3 4 5
1. Upon reaching the home ,selected a work area which is well lighted and dry where the
bag can be placed and set up place bags away from children and domestic animals
2. Spread newspaper /spread sheet on a flat ,clean surface on a mat /dhari and place the bag
on left hand side of the newspaper .make a paper bag and place on the right top corner of
the bag
3. Unbutton the outer lining of the bag ,remove the hand washing articles .identify a wash
area ,seek help from the family and wash hands
4. Remove apron from the bag and put it on if necessary
5. Remove necessary supplies and equipments and place on a clean area on newspaper
6. Close the bag (half cover )
7. Carryout the required nursing procedure place soiled swabs inside the newspaper bag for
dispose
8. Give the newspaper bag with soiled swabs etc .to family for proper disposal by burning
9. Clean the use articles by using running water
10. Use articles that can not be processed during field visit should be wrapped well with
newspaper and to be placed in the outside compartment for further processing
11. Place articles which are contaminated with infected material in a plastic cover and carry
separately for autoclaving
12. Wash hands and open the bag to return articles into the bag
13. Use a cotton swab moistened with sprit and wipe outside of use bottle and bowl and replace
in the bag
14. Wash sanitize hands and close the bag
15. Fold the newspaper with used side inside the place it in the
side pocket and carry the bag
16. Write a report of observation the procedure done healthtalk given to the family planned for
the next visit
INSTRUCTIONS :
Scoring is to be given as :
Performed well -2 perfromed average -1 did not performed -0
MAXIMUM SCORE :16
SCORE OBTAINED :
REMARKS :
SIGNATURE OF STUDENT/FACULTY SIGNATURE OF SUPERVISOR