Daily Observation Report Form

Combined Daily Observation Report Form

Complete the Daily Observation Report based on today's shift. Choose the DOR type to load the correct sections.
Shift Date

MonthDayYear
Date
Lead Medic/FTO

First NameLast Name
Trainee Name

First NameLast Name
Trainee Level
Length of Shift
Station
DOR Type
- Rating Scale Information
  
  The following questions will be rated using a scale of 1 to 5, with 5 being the best. If a skill or behavior was not observed, please SKIP question.
- Was the FTEP Task Book reviewed? Be sure to document any tasks completed and any competency assessments.
- Professionalism: Punctual arrival to shift, ready for duty.
  
  1
  
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  4
  
  5
  
  1 is Need Improvement, 5 is Best
- Professionalism: Ensures truck and equipment readiness
  
  1
  
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  3
  
  4
  
  5
  
  1 is Need Improvement, 5 is Best
- Appearance: Uniform is clean, ironed and neat.
  
  1
  
  2
  
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  4
  
  5
  
  1 is Need Improvement, 5 is Best
- Driving: New hire operates vehicles appropriately. (Easy turns, no harsh accelerations, understands geotab, tremco and brake lock operations etc.)
  
  1
  
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  5
  
  1 is Needs Improvement , 5 is Excellent
- Driving Safety: New hire operates vehicles safely including appropriate speeds both routine and emergency, comes to a complete stop at intersections when emergency, etc
  
  1
  
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  4
  
  5
  
  1 is Needs Improvement , 5 is Excellent
- Communication (Radio): Employee communicates clearly and calmly on the radio on scene and when calling Communications. Understands how to navigate channels, banks and simplex.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Communication (Patient/Family): Effective and clear communication between new hire and patient/family. Conveys information in a way that is easily understood. Actively listen to the patient's concerns, needs, and preferences
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Communication (Inter-Agency): Communication on scene with partner agencies is respectful, clear and concise.
  
  0
  
  1
  
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  5
  
  0 is Need Improvement, 5 is Best
- Communication (Clinical): Radio reports and hand off reports include appropriate amount of and pertinent information for each. Communication with hospital staff is thorough and professional.
  
  0
  
  1
  
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  4
  
  5
  
  0 is Need Improvement, 5 is Best
- Operations (County Ops): New hire is able to listen to radio traffic and understand unit availability/operations. Employee is proactive about staging, scene times and transferring care based on knowledge of county ops.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Operations (Scene Management): New hire is able to respectfully & clearly provide direction in a timely manner on scene. They demonstrate ability to delegate tasks to responders on scene.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Operations (Time Management): New hire is able to assess patient, create plan, initiate treatment and call in report to receiving facility in an organized and timely manner.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Clinical (Pathophysiology): New hire demonstrates understanding of disease processes and associated symptoms.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Clinical (Pharmacology): New hire demonstrates competency in selecting correct medications and correct doses based on patient presentation.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Clinical (Treatment): New hire is able to formulate and carry out appropriate treatment plans for their primary differential diagnosis.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Clinical (Differential Diagnosis): New hire is able to formulate a thorough or appropriate differential diagnosis given the pts presentation and clinical findings.
  
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  5
  
  1 is Need Improvement, 5 is Best
- Clinical (Clinical Reasoning): New hire is able to rationalize in patient-centered terms why or why not specific interventions were performed.
  
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  5
  
  1 is Need Improvement, 5 is Best
- Clinical (Documentation): Documentation is clear, accurate, detailed and completed in a timely manner with little to no coaching required.
  
  1
  
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  5
  
  1 is Need Improvement, 5 is Best
- Summarize feedback in OPERATIONS, COMMUNICATION and CLINICAL; please summarize any REMEDIAL EFFORTS and FUTURE TRAINING GOALS.
- Rating Scale Information
  
  The following questions will be rated using a scale of 1 to 5, with 5 being the best. If a skill or behavior was not observed, please SKIP question.
- Professionalism: Arrives on time and ready for shift, ensures truck and equipment are operational, and maintains a clean, neat, and professional uniform appearance.
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Needs Improvement, 5 is Best
- Driving Safety & EMT Skill Knowledge: Demonstrates safe, responsible driving practices; displays competency in core EMT knowledge and skills appropriate for their credential level.
  
  1
  
  2
  
  3
  
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  5
  
  1 is Needs Improvement, 5 is Best
- CAD System Usage (Accuracy & Efficiency): Correctly operates the CAD system, quickly updating statuses and information without errors.
  
  1
  
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  5
  
  1 is Needs Improvement, 5 is Best
- ESO Charting & Documentation Quality: Completes clear, accurate, and thorough documentation of patient encounters using ESO.
  
  1
  
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  5
  
  1 is Needs Improvement, 5 is Best
- Patient & Team Interaction During Calls: Communicates effectively with patients and crew members, demonstrating professionalism and teamwork.
  
  1
  
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  5
  
  1 is Needs Improvement, 5 is Best
- Restocking & Equipment Readiness Post-Call: Consistently restocks and prepares equipment after each call, ensuring readiness for the next response.
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Needs Improvement, 5 is Best
- Summarize feedback in OPERATIONS, COMMUNICATION and CLINICAL; please summarize any REMEDIAL EFFORTS and FUTURE TRAINING GOALS.
- Rating Scale Information
  
  The following questions will be rated using a scale of 1 to 5, with 5 being the best. If a skill or behavior was not observed, please SKIP question.
- Advanced Patient Assessment: Recognition of ALS indicators, decision-making.
  
  1
  
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  3
  
  4
  
  5
  
  1 is Needs Improvement, 5 is Best
- Skill Competency: Skill accuracy, effectiveness, and speed.
  
  1
  
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  5
  
  1 is Needs Improvement, 5 is Best
- Medication Administration: Correct dosages, appropriate meds, safety
  
  1
  
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  5
  
  1 is Needs Improvement, 5 is Best
- Advanced Airway Management: Intubation, supraglottic devices, ventilations
  
  1
  
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  5
  
  1 is Needs Improvement, 5 is Best
- EKG Interpretation & Cardiac Management: Recognition of rhythms, appropriate treatment.
  
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  5
  
  1 is Needs Improvement, 5 is Best
- Critical Decision-Making & Leadership: Clear leadership, decisive actions, patient advocacy.
  
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  5
  
  1 is Needs Improvement, 5 is Best
- Summarize feedback in OPERATIONS, COMMUNICATION and CLINICAL; please summarize any REMEDIAL EFFORTS and FUTURE TRAINING GOALS.
- Types of Critical Incidents
- Paramedic’s Role on Incident
- Incident Performance Summary: What went well?
- Incident Performance Summary: Areas needing improvement?
- Was this DOR reviewed IN PERSON with the Trainee?
- Trainee Email
  example@example.com
- Should be Empty:

Combined Daily Observation Report Form

Rating Scale Information

Rating Scale Information

Rating Scale Information