Supervisor's Daily Report
To be completed and submitted by 0800 for the prior 24-hour operational period.
Shift Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Start date of 24-hour operational period
Supervisor's Name
*
First Name
Last Name
Supervisor's Email
*
Staffing
Employee Call-Off (sick/emergency/etc.)
Employee Call-Back/Call-In
Fatigue Respite
Daily Call Log
Delays to Calls/Inter-Facility Transfers
Provide a detailed explanation for each delay in response to a call or inter-facility transfer, including time and duration of delay as well as the cause. Be sure to reference the incident number.
Refused Calls/Inter-Facility Transfers
Provide a detailed explanation for any refused call or inter-facility transfer, including time and reason. Be sure to reference the incident number if one was assigned.
Cancelled Inter-Facility Transfer
Provide a detailed explanation for any cancelled inter-facility transfer, including time and reason. Be sure to reference the incident number if one was assigned.
Unusual Occurrences
Provide a detailed explanation for any unusual occurrence and confirm that the Medstar Incident Report form was completed and submitted for each event.
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