Republic of the Philippines

SULTAN KUDARAT STATE UNIVERSITY

EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Table of Contents
BOBIS, CHRISTIAN ACE G. Score
Activity 1: Proper Handwashing and Donning and Doffing of Personal
Protective Equipment (PPE)
Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 2: Locating Proper Site and Anchoring Vein in Venipuncture

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 15

Activity 3: Familiarization with Phlebotomy Materials

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 20

Activity 4: Commonly Used Blood Collection Additives and Order of Draw

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.1: Venipuncture through Evacuated Tube System (Single Draw)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.2: Venipuncture through Evacuated Tube System (Multiple Draw)

Student Laboratory Activity Performance Evaluation 2
Student Post-Laboratory Activity Performance Evaluation 10
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 5.3: Venipuncture Using Syringe

Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.4: Venipuncture Using Butterfly

Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 10

Activity 6: Familiarization with Capillary Blood Collection Materials.

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 7: Capillary Blood Collection (Skin Puncture) Following the Proper

Order of Draw
Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 30

Activity 8: Blood Collection for Culture

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 9: Accomplishing the Chain of Custody and Control Forms for Drug
Testing
Custody and Control Forms
I. Drug Test Request
II. Drug Test Certification
III. Custody and Control Form 001: Consent Form
IV. Custody and Control Form 002A: Copy for the Donor
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

V. Custody and Control Form 002B: Copy for the Collection Site
VI. Custody and Control Form 002C: Copy for the Laboratory
VII. Custody and Control Form 002D: Copy for the Confirmatory
Laboratory
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 10: Bleeding Time Determination (Duke's Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 11: Coagulation Time Determination (Slide Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 12: Preparation of Serum or Plasma for Laboratory Testing

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 13: Point-of-Care Testing (Glucometer)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 14: Collection and Preparation of Urine Specimen for Laboratory

Testing
Student Laboratory Activity Performance Evaluation

Student Post-Laboratory Activity Performance Evaluation

 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 15: Physical and Chemical (Reagent Strip) Examination of Urine

Specimen
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Table of Contents
BORLING, KIMBERLINE A. Score
Activity 1: Proper Handwashing and Donning and Doffing of Personal
Protective Equipment (PPE)
Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 2: Locating Proper Site and Anchoring Vein in Venipuncture

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 5

Activity 3: Familiarization with Phlebotomy Materials

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 18

Activity 4: Commonly Used Blood Collection Additives and Order of Draw

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.1: Venipuncture through Evacuated Tube System (Single Draw)

Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.2: Venipuncture through Evacuated Tube System (Multiple Draw)

Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 10
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 5.3: Venipuncture Using Syringe

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.4: Venipuncture Using Butterfly

Student Laboratory Activity Performance Evaluation 2
Student Post-Laboratory Activity Performance Evaluation 10

Activity 6: Familiarization with Capillary Blood Collection Materials.

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 7: Capillary Blood Collection (Skin Puncture) Following the Proper

Order of Draw
Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 30

Activity 8: Blood Collection for Culture

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 9: Accomplishing the Chain of Custody and Control Forms for Drug
Testing
Custody and Control Forms
I. Drug Test Request
II. Drug Test Certification
III. Custody and Control Form 001: Consent Form
IV. Custody and Control Form 002A: Copy for the Donor
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

V. Custody and Control Form 002B: Copy for the Collection Site
VI. Custody and Control Form 002C: Copy for the Laboratory
VII. Custody and Control Form 002D: Copy for the Confirmatory
Laboratory
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 10: Bleeding Time Determination (Duke's Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 11: Coagulation Time Determination (Slide Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 12: Preparation of Serum or Plasma for Laboratory Testing

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 13: Point-of-Care Testing (Glucometer)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 14: Collection and Preparation of Urine Specimen for Laboratory

Testing
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 15: Physical and Chemical (Reagent Strip) Examination of Urine

Specimen
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Table of Contents
BOSE, JULIANA NICOLETTE C. Score
Activity 1: Proper Handwashing and Donning and Doffing of Personal
Protective Equipment (PPE)
Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 2: Locating Proper Site and Anchoring Vein in Venipuncture

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 3: Familiarization with Phlebotomy Materials

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 20

Activity 4: Commonly Used Blood Collection Additives and Order of Draw

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.1: Venipuncture through Evacuated Tube System (Single Draw)

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.2: Venipuncture through Evacuated Tube System (Multiple Draw)

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 5.3: Venipuncture Using Syringe

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.4: Venipuncture Using Butterfly

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 6: Familiarization with Capillary Blood Collection Materials.

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 7: Capillary Blood Collection (Skin Puncture) Following the Proper

Order of Draw
Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 30

Activity 8: Blood Collection for Culture

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 9: Accomplishing the Chain of Custody and Control Forms for Drug
Testing
Custody and Control Forms
I. Drug Test Request
II. Drug Test Certification
III. Custody and Control Form 001: Consent Form
IV. Custody and Control Form 002A: Copy for the Donor
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

V. Custody and Control Form 002B: Copy for the Collection Site
VI. Custody and Control Form 002C: Copy for the Laboratory
VII. Custody and Control Form 002D: Copy for the Confirmatory
Laboratory
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 10: Bleeding Time Determination (Duke's Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 11: Coagulation Time Determination (Slide Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 12: Preparation of Serum or Plasma for Laboratory Testing

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 13: Point-of-Care Testing (Glucometer)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 14: Collection and Preparation of Urine Specimen for Laboratory

Testing
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 15: Physical and Chemical (Reagent Strip) Examination of Urine

Specimen
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Table of Contents
BUENBRAZO, MARIA LWELYN A. Score
Activity 1: Proper Handwashing and Donning and Doffing of Personal
Protective Equipment (PPE)
Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 2: Locating Proper Site and Anchoring Vein in Venipuncture

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 3: Familiarization with Phlebotomy Materials

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 20

Activity 4: Commonly Used Blood Collection Additives and Order of Draw

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.1: Venipuncture through Evacuated Tube System (Single Draw)

Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.2: Venipuncture through Evacuated Tube System (Multiple Draw)

Student Laboratory Activity Performance Evaluation 2
Student Post-Laboratory Activity Performance Evaluation 10
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 5.3: Venipuncture Using Syringe

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 5.4: Venipuncture Using Butterfly

Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 10

Activity 6: Familiarization with Capillary Blood Collection Materials.

Student Laboratory Activity Performance Evaluation 15
Student Post-Laboratory Activity Performance Evaluation 10

Activity 7: Capillary Blood Collection (Skin Puncture) Following the Proper

Order of Draw
Student Laboratory Activity Performance Evaluation 7
Student Post-Laboratory Activity Performance Evaluation 15

Activity 8: Blood Collection for Culture

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 9: Accomplishing the Chain of Custody and Control Forms for Drug
Testing
Custody and Control Forms
I. Drug Test Request
II. Drug Test Certification
III. Custody and Control Form 001: Consent Form
IV. Custody and Control Form 002A: Copy for the Donor
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

V. Custody and Control Form 002B: Copy for the Collection Site
VI. Custody and Control Form 002C: Copy for the Laboratory
VII. Custody and Control Form 002D: Copy for the Confirmatory
Laboratory
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 10: Bleeding Time Determination (Duke's Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 11: Coagulation Time Determination (Slide Method)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 12: Preparation of Serum or Plasma for Laboratory Testing

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 13: Point-of-Care Testing (Glucometer)

Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation

Activity 14: Collection and Preparation of Urine Specimen for Laboratory

Testing
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Activity 15: Physical and Chemical (Reagent Strip) Examination of Urine

Specimen
Student Laboratory Activity Performance Evaluation
Student Post-Laboratory Activity Performance Evaluation