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Workplace Naloxone Training Checklist (Injection)

Naloxone may be administered only by personnel who’ve received proper training. Here’s a Checklist you can use to verify such training where naloxone is administered via injection.

Knowledge Check for Administering Naloxone Trainer Initials Trainee Initials Date
Successful completion of naloxone administration training
Accurately identifies location(s) of naloxone at the workplace
Accurately identifies necessary supplies
Accurately reads and follows instructions on naloxone box
Accurately identifies Workplace Naloxone Coordinator
Accurately describes incident reporting procedures
Accurately describes incident documentation procedures
Skills Check for Administering Naloxone Trainer Initials Trainee Initials Date
Assessing the victim including shake, shout and sternal rub
Calling/instructing someone to call 911 and activate workplace emergency response
Obtaining and correctly administering Naloxone following each step below:
1. Lay victim on their back to administer Naloxone
2. Remove medication from box, peel back tab with a circle to open
3. Place tip of auto-injector on either side of outer thigh, may use through clothing after ensuring there are no contents obstructing device
4. Press hard into thigh until mechanism injects
6. Massage injection site for 10 seconds to help absorption
7. Turn victim to their side (recovery position)
8. Monitor victim, administer rescue breathing if needed, (i.e., if no response to talking, touch or pain, additional Naloxone may be administered every 2-3 minutes if available, until the victim responds or EMS arrives)
9. If needed, follow steps 2-8 using a new Naloxone injection in the other thigh
10. Put the used Naloxone back in the box and give to EMS for disposal
11. Document administration according to Company policy/protocol
Training is valid for one year; review during the year is highly recommended