EMT Psychomotor Exam Skills Verification

Online Psychomotor Exam Skills Verification

Instructions for completion of EMT Skills Verification Form

1. A completed EMT Skills Verification Form (EMSA-SCV 01/17) is required for those individuals who are either renewing or reinstating their EMT certification. This verification form must accompany the application. The form can be downloaded below.
2. Verification of skills competency shall be accepted as valid to apply for EMT renewal or reinstatement for a maximum of two (2) years from the date of skill verification.
3. The EMT that is being skills tested shall provide their complete name as shown on their California EMT certification, the EMT certificate number and signature in the spaces provided.
4. Verification of Competency 

Skills competency will be demonstrated by direct observation of a simulated patient contact, i.e. skills station.  The individual verifying competency shall:

1. Sign the EMT Skills Competency Verification Form for that skill.
2. Print their name on the EMT Skills Competency Verification Form for that skill.
3. Enter the date that the individual demonstrated the competency of the skill.
4. Provide the name of the organization that has approved them to verify skills.
5. Provide their certification or license type and number.

Please prepare in advance for your scheduled skills check off by reviewing the skills forms which can be downloaded via the red writing on this page

California Code of Regulations

Title 22, Division 9, Chapter 2
Emergency Medical Technician
Section 100080

EMSA-SCV (08/10) is herein incorporated by reference.  Skills competency shall be verified by direct observation of an actual or simulated patient contact. Skills competency shall be verified by an individual who is currently certified or licensed as an EMT, EMT-II, Paramedic, Registered Nurse, Physician’s Assistant, or Physician and who shall be designated by an EMS approved training program (EMT training program, paramedic training program or CE provider) or an EMS service provider; EMS service providers include, but are not limited to public safety agencies, private ambulance providers and other EMS providers. Verification of skills competency shall be valid for a maximum of two (2) years for the purpose of applying for recertification. The skills requiring verification of competency are:

1. Patient examination, trauma patient
2. Patient examination, medical patient
3. Bag Valve Mask Ventilation
4.  Oxygen Administration
5. Cardiac Arrest Management with AED
6. Hemorrhage Control and Shock Management
7. Spinal Motion Restriction – Supine and Seated
8. Penetrating Chest Injury
9. Epinephrine and Naloxone Administration
10. Childbirth and Neonatal Resuscitation
11. Glucometer and blood sugar testing

Click here to download the skills checkoff form.

Or NREMT Forms Here.

Please don’t forget to fill out form.