End of Shift Report

End of Shift Report

Please fill out this form to report a summary of patient contacts and equipment use.
When filling out this report, avoid using any personal information (i.e. name, phone number, student number). You may use the following template:

Age+Sex+ Chief complaint, Interventions, Disposition

e.g. 24F Laceration on sole of left foot, Cleaned, iced and bandaged, Return to event site.

where 24F refer to the patient's age and gender, followed by chief complaint.

Additionally, report any used gear, and the kit it was taken from (i.e. 3 gauze pads from Avocado #1, 2 ice packs from Trauma Kit, etc)
Name*

First NameLast Name
Email*
example@example.com
Event summary
Event*
Date of event*

MonthDayYear
Date
NO PATIENT CONTACTS
Number of patient interactions*
Number of product requests*
Was there any EMS transports?*
Summary of numbered patient interactions. (Please follow the template outlined above)*
What supplies did you use from the kits?*
Should be Empty:

Event summary