Suturing Lab Skill Check Off Form
Student Name
First Name
Last Name
Suturing
Rows
Tentative or awkward positioning, poor use of instruments, inappropriate suture, obvious deficiencies
Competent of use of instruments but appears awkward, generally competent but somewhat inefficient, some prompting and redirection needed
Fluid moves with instruments and no awkwardness, always ties knots efficiently, demonstrates proper technique, performs procedure with near total independence
Demonstrates Proper Instrument Technique
1
2
3
Demonstrates Proper Technique in Performing Instrument Knot Tying
4
5
6
Demonstrates proper needle insertion and bite size
7
8
9
Demonstrates proper technique in performing a simple suture
10
11
12
Demonstrates proper technique in performing a vertical mattress suture
13
14
15
Demonstrates proper technique in performing a horizontal mattress suture
16
17
18
Demonstrates proper technique in performing a corner stitch
19
20
21
Overall Knowledge of Procedure
22
23
24
Overall Performance
25
26
27
Faculty Name
First Name
Last Name
Signature
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