Compression Stocking Competency Checklist Form
Use this checklist to assess training, understanding, and correct use of compression stockings.
Participant and Training Information
Participant Name
*
First Name
Middle Name
Last Name
Training Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Role or Relationship to Patient
Evaluator Name
*
First Name
Middle Name
Last Name
Training Location / Setting
*
Compression Stocking Competency Checklist
Understands the purpose of compression stockings
*
Yes, clearly understands
Somewhat understands
Needs further training
Knows how to confirm correct sizing and fit
*
Accurately checks size and fit
Needs assistance with fit checks
Does not yet know how to check
Can put stockings on correctly
*
Independently and correctly
With occasional prompts
Not yet able to perform correctly
Can remove stockings safely
*
Independently and safely
With occasional prompts
Not yet able to perform safely
Recognizes signs of improper fit or circulation problems
*
Pain or discomfort
Numbness or tingling
Skin color changes
Marks, pinching, or rolling at the top
Swelling that worsens
Cold or pale toes
Other concerning changes
Understands wear schedule and duration
*
Does not understand
1
2
3
4
5
6
7
8
9
Fully understands
10
1 is Does not understand, 10 is Fully understands
Knowledge of care, storage, and when to seek help
*
Rows
Correct
Needs Review
Skin care and hygiene practices
1
2
Laundering and drying instructions
3
4
Storage and replacement knowledge
5
6
When to seek help or report issues
7
8
Overall competency with compression stocking care and use
*
Competent
Competent with supervision
Needs retraining
Evaluator Outcome and Follow-Up
Final competency decision
*
Competent
Not yet competent
Requires further observation
Remediation or retraining required
Refresher training
Supervised practice
Repeat competency assessment
Reviewed procedure materials
Other
Observed issues and evaluator notes
Follow-up training or review date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Checklist
Should be Empty: