EMS TRAINING PROGRESS REPORT
The Use & Location of Part 800 Equipment & Supplies
Date
*
-
Month
-
Day
Year
Date
Trainee Name
*
First Name
Last Name
Document Check
The following are available on the trainee record:
Orientation Quiz
Bloodborne pathogen Acknowledgment
Hepatitis B Vaccine Consent/Refusal
MVR Release with Driver's License
Emergency Contact Information
BLS CPR card
Notes:
Skill Assessment
Skill Check
Rows
ND
NFD
S
E
Comments
Rig Check
Housekit Check
Stretcher
Reeves
Lyft/Loader
Suction
Lucas
Backboard
Stairchair
Scoop
KED
Overall feedback
The Trainee
*
Please Select
has demonstrated the necessary knowledge and skills required
needs further support to achieve the necessary skill competence
Instructor Name
*
First Name
Last Name
Instructor Signature
*
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