Brentwood Legion Ambulance
Probationary Evaluation
Personal Information
To Be Completed After Every Tour For Probationary Members
Probationary Members Name:
*
First Name
Last Name
Date of Tour:
*
-
Month
-
Day
Year
Date
Tour:
*
0000-0600
0600-1200
1200-1800
1800-0000
Other
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Did The Probationary Member Utilize All Equipment Appropriately?:
*
Yes
No
Other
Did The Probationary Member Follow Direction From Other Crew Members?:
*
Yes
No
Other
Was The Probationary Member Eager To Learn And Take Guidance From Other Crew Members?:
*
Yes
No
Other
Did The Probationary Member Act Appropriately On Calls?:
*
Yes
No
Other
Did The Probationary Member Complete A Rig Check?:
*
Yes
No
Unknown
Other
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Skills Completed
Please Select All Performed Skills And Add Comments As Needed.
Select All Applicable Skills:
*
Blood Pressure - Manual
Blood Pressure - Automated
Manual Pulse
Lung Sounds
Blood Sugar - Requires Assistance
Blood Sugar - No Assistance
Oxygen Setup/ Administration
Using the Stretcher
Use of the Stairchair
Use of Reeves
Cervical collar
Bleeding Control
Obtaining Demographics/ Insurance
Cleaned Stretcher/ Equipment Appropriately
Other
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Comments and Suggestions For Future Training
Other Comments:
*
Any Recommendations For Future Trainings:
*
Evaluating Member or Employee Name:
*
Enter the Message As It's Shown:
*
Submit
Should be Empty: