| SN | CHARACTERISTICS TO BE OBSERVED | PERFOMANCE | ||
| YES | NO | N/A | ||
| 1 | Discussion with a patient about the procedure |
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| 2 | Ensure cleanliness and safety of environment |
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| 3 | Ensure privacy |
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| 4 | Wash hands before and after procedure |
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| 5 | Assemble all needed supplies |
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| 6 | Place waste bag for soiled items within reach |
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| 7 | Close room or cubicles curtain or screen around |
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