Advanced Practice Esthetics Practical Skills Test Results Form - 2019 - Signature

Sep 20, 2026

Uploaded by Bintang

Advanced Practice Esthetics Practical Skills Test Results Form for documenting student and examiner certifications and the measured outcomes of practical skills testing. The form collects student identity details and exam date, and includes examiner witness certification under MN Statute 155A.33, Subd. 4-6. It provides checklist sections for advanced exfoliation (chemical peel, machine/device options), advanced skin care techniques, and skin needling, with pass/fail status plus automatic fail incident categories and required important instructions.

LanguageEnglish

CategoryExam

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Student Information & Certifications

Results Certification by Student

Results Certification by Examiner

Practical Skills Checklists

Advanced Exfoliation: Chemical Peel

Advanced Skin Care Techniques

Advanced Exfoliation: Machine or Device

Skin Needling

Automatic Fail Incidents & Important Details

Automatic Fail Incidents

Important Details

1000 University Avenue W, Suite 100 | St. Paul, MN 55104 [cosmetology@state.mn.us | mn.gov/boards-cosmetology](cosmetology@state.mn.us | mn.gov/boards-cosmetology) Advanced Practice Esthetics Practical Skills Test Results Form Student Name: Birth Date: Results Certification by Student I certify, under penalty of MN Statute 155A.33, Subd. 4-6, that the scores reflected on this Practical Skills Test Results Form are true and accurate. Printed Name: Signature: Date: Results Certification by Examiner I certify, under penalty of MN Statute 155A.33, Subd. 4-6, that I have witnessed the examinee listed above take the Practical Skills Test and obtain the scores reflected on this form. Printed Name: School Name: School Location: Exam Date: Examiner Name: Examiner Title: | | | --- | | | | | | | | Advanced Exfoliation: Chemical Peel | | | | --- | --- | --- | | Pre-Service | | | | 1. Client consultation | Y | N | | 2. Skin analysis | Y | N | | 3. Consent form | Y | N | | Set Up | | | | 1. Wash hands | Y | N | | 2. Prepare work area | Y | N | | 3. Drape model | Y | N | | Service | | | | 1. Wear gloves | Y | N | | 2. Prepare model’s face | Y | N | | 3. Apply peel | Y | N | | 4. Monitor peel | Y | N | | 5. Neutralize peel, if applicable | Y | N | | 6. Apply finishing product, if applicable | Y | N | | Completion | | | | 1. After care directions | Y | N | | 2. Clean and disinfect | Y | N | | Circle one: Passed Section Failed Section | | | | If failed, list reason: | | | | Advanced Skin Care Techniques | | | | --- | --- | --- | | Pre-Service | | | | 1. Client consultation | Y | N | | 2. Skin analysis | Y | N | | 3. Consent form | Y | N | | Set Up | | | | 1. Wash hands | Y | N | | 2. Prepare work area | Y | N | | 3. Drape model | Y | N | | Service | | | | 1. Prepare model’s face | Y | N | | 2. Lymphatic drainage massage and electrical energy treatment | Y | N | | 3. Application and removal of mask | Y | N | | 4. Apply finishing product | Y | N | | Completion | | | | 1. After care directions | Y | N | | 2. Clean and disinfect | Y | N | | Circle one: Passed Section Failed Section | | | | If failed, list reason: | | | | Advanced Exfoliation: Machine or Device | | | | --- | --- | --- | | Pre-Service | | | | 1. Client consultation | Y | N | | 2. Skin analysis | Y | N | | 3. Consent form | Y | N | | Set Up | | | | 1. Wash hands | Y | N | | 2. Prepare work area | Y | N | | 3. Drape model | Y | N | | Service | | | | 1. Wear gloves | Y | N | | 2. Prepare model’s face | Y | N | | 3A. Dermaplane procedure | Y | N | | 3B. Crystal microdermabrasion procedure | Y | N | | 3C. Diamond microdermabrasion procedure | Y | N | | 3D. Hydradermabrasion | Y | N | | 4. Apply finishing product | Y | N | | Completion | | | | 1. After care directions | Y | N | | 2. Clean and disinfect | Y | N | | Circle one: Passed Section Failed Section | | | | If failed, list reason: | | | | Automatic Fail Incidents | | | --- | --- | | A. Injured client or self | F. Used prohibited or unclean item | | B. Failed to detect allergy or contraindication that would cause significant harm | G. Improperly used machine, device, tool, or product | | C. Contaminated unused product | H. Failed to complete service | | D. Did not wash hands prior to service | I. Cheated | | E. Did not where gloves when appropriate; Did not wash hands or replace gloves when contaminated | J. Violated Minnesota Statute 155A or Rule Chapters 2105 or 2110 | | Important Details | | | --- | --- | | • A separate Results Form must be used for each test day. Any section that is not tested must be crossed off of the form.
• The examiner must circle whether the student passed or failed and note any Automatic Fail Incidents that occurred.
• Each Results Form must show accurate information and be signed. | | | Skin Needling | | | | --- | --- | --- | | Pre-Service | | | | 1. Client consultation | Y | N | | 2. Skin analysi

FAQs

What does the student certification section require?

The student certifies, under penalty of MN Statute 155A.33, Subd. 4-6, that the scores shown on the form are true and accurate, and provides printed name, signature, and date.

How does the examiner certification work on the form?

The examiner certifies under penalty of MN Statute 155A.33, Subd. 4-6, that they witnessed the examinee take the Practical Skills Test and obtain the scores reflected on the form, including printed name, school details, exam date, and examiner title.

Which events are listed as automatic fail incidents?

Automatic fail incidents include an injured client or self; failure to detect allergy/contraindication; contaminated unused product; failure to wash hands or use gloves appropriately; use of prohibited/unclean items; improper use of machine/device/tool/product; failure to complete the service; cheating; and violations of Minnesota Statute 155A or Rule Chapters 2105 or 2110.

Sep 20, 2026

Uploaded by Bintang