EVOC daily observation report
IWVRS Daily Observation Report, EVOCUtilization of this form is to track precepting members and students as they move through IWVRS programs. FTO's, members, and students should understand that a low "grade" is expected durning the beginning shifts of these programs. FTO, you are expected to accurately capture the current ability and knowledge of each student or Precepting members utilizing a 1-5 scale or NA if skill does not apply. Please follow the guidance below for accurate "grading".1 - represents frequent failure in knowledge, management, and skills. (Beginner)2 - represents inconsistency in knowledge, management, and skills, needing prompting in multiple aspects. (Novice) 3 - represents consistency in knowledge, management, and skills with little prompting from mentor. (proficient) 4 - represents consistency in knowledge, management, and skills with no prompting from mentor. (Competent) 5 - represents an expert level clinician. While we should all strive for this level, it would be extremely rare to be at this level.
Preceptee name
First Name
Last Name
Preceptee email
example@example.com
FTO name
First Name
Last Name
FTO email
example@example.com
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift hours
Mechanical Check
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Checking fluids, lights, tires, gages, and knows who to contact should an issue be found.
Ensure seat belts, seat positioning and mirrors are set appropriately.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Able to navigate roads at an appropriate speed, safely and comfortably.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Maintains safety of self, passengers, and community.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Follows road laws, and due regard.
Please Select
Utilized Commentary Driving.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Commentary driving is verbally communicating with the FTO what the Preceptee is seeing around them, noticing and thinking a they are preparing and driving.
Familiar with main county roads and landmarks.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Familiar with hospitals.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Familiar with secondary roads.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
Backing skills.
Please Select
1 (beginner)
2 (Novice)
3 (proficient)
4 (Competent)
5 (Expert )
6 NA
We're lights and sirens utilized on any calls on this shift?
Preceptee strengths.
What should the preceptee we be working of for the next shift?
FTO comments
Preceptee comments
FTO signature
Preceptee signature
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