End of Shift Report

This form has geolocation activated. Your location must be allowed on your smart device and your web browser. This form must be completed onsite with the authorised site contact at the end of your shift.*

This form has geolocation activated. Your location must be allowed on your smart device (and web browser) and you must have a steady internet connection. There is no option to save and continue later, this form must be completed and submitted onsite with the authorised site contact at the end of your shift.

Date*

Shift Date

Client Name starts with*

A-F (incl. start with a number)G-OP-Z

Client

Please use the FULL NAME of client, ie: Metro Trains Melbourne Pty Ltd or Yarra Valley Grammar School

Client Name A-F*

Please use the FULL NAME of client, ie: Metro Trains Melbourne Pty Ltd or Department of Defence

Client Name G-O*

Please use the FULL NAME of client, ie: Metro Trains Melbourne Pty Ltd or Yarra Valley Grammar School

Client Name P-Z*

Please use the FULL NAME of client, ie: Metro Trains Melbourne Pty Ltd or Yarra Valley Grammar School

Venue*

Please select an existing option from this list. If Venue not available use free-text.

Venue Sydney Trains*

Please choose a Station from the list

Venue Melbourne Trains*

Please choose a Station from the list

Planning & Projects - MTM*

Please choose a Station from the list

Shift Type*

Club Name

Site location or address

Classification*

Start Time*

Hour Exact Minutes

End Time*

Hour Minutes

Break*

Total break time (E.g. 15 min = 0.25)

Hour Calculation

Total Minutes Calculation

Difference Minutes Calculation

Hours Worked*

Auto generated - Do not edit!

PCRs Submitted

Total PCR's for your shift (leave blank if no PCR's)

Ambulance required

Please leave blank if 0

Information requests*

Treatments including transports

Ambulance Transports

I declare that I have check the first aid equipment located at this station and all items are working and accounted for.*

YesNo

Complaints Sydney Trains received from Customers relating to the standard of care provided by the Paramedic *

Compliments Sydney Trains received from Customers relating to the standard of care provided by the Paramedic *

Safety related incidents (incidents which cause or may cause harm, infection, injury or death) caused or contributed to by the Paramedic *

Can you provide a suggestion for innovative value adding/continuous improvement initiatives to improve process efficiency, safety, value delivery, service or operational efficiencies and drive best practice? *

YesNo

Was the Paramedic Response Back restocked from overstock?

YesNo

Site Contact Name*

First NameLast Name

Site Contact Position*

Site Contact must have full name and be authorised to sign off on hours completed

Site Contact Signature*

Colmed Policy: you must ensure your Shift Report is signed off by the site contact. You will delay payroll if it is incomplete as verification must be approved prior to invoicing.

Would the site contact like a copy of your Shift Report via email?*

YesNo

Site Contact Email

example@example.com

If site contact is unable to sign, please state reason(s) why:

All reports must be signed off by the site contact for accurate payroll and invoicing

Treatment Summary

	Time Called	Time On Scene	Station PT Boarded	Age Group	Gender	Presentation	Chief Complaint	ATS Triage	Discharge Cat.	Extric. Delay
1
2
3
4
5

Self Treatment Summary

	Reason / Comment	Total
Ice request for pre-existing injury/condition only
Band aid requested and self applied by patron (blisters or pre-existing lacerations only)
Sunscreen request
Request for safety pins
Request for sports taping - unable to provide (medic not qualified in taping)
Request for sports taping - taping provided (tape to be supplied by athlete or client)
Request for emesis bag
Request for general medical advice (pre existing injuries only)
Request for Event Information

Name*

First NameLast Name

Medic Email*

example@example.com

File Upload

Upload any supporting documentation where required.

Employee Signature*

I confirm that the information provided within this Shift Report is 100% accurate

Shift Notes

Please provide any important notes which you would like to report back to Colmed management, relating to: site specific information, equipment or recommendations at future shifts

Colmed Group

operations@colmedgroup.com

Please note:

1. Falsification of employment or work-related records is a serious matter.

2. Any fraudulent Shift Report and/or confirmation of hours will be construed as serious misconduct, in accordance with financial gain by deception (in Victoria, this is covered by sections 81 and 82 of the Crimes Act 1958) and will provide lawful grounds for instant dismissal.

3. All Shift Reports must include a site contact name and signature; unless pre-approved by Colmed management.

4. This Shift Report (and included attendance slip) must be uploaded to VT Events whilst confirming your hours immediately following your shift.