Workplace Naloxone Training Checklist (Nasal Spray)

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 nasal spray.

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. Hold Naloxone spray with thumb on the bottom of the plunger and the third and middle fingers on either side of the nozzle
4. Tilt the victim’s head back while using your hand to provide support under the neck
5. Gently insert the tip of the nozzle until the fingers on either side of the nostril are against the bottom of the victim’s nose
6. Press the plunger firmly to give the dose of Naloxone nasal spray
7. Remove Naloxone nasal spray and 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 nasal spray 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 nasal spray in the other nostril
10. Put the used Naloxone nasal spray 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