N.E.W Rescue Task Force Equipment Evaluation Form

N.E.W Rescue Task Force Equipment Evaluation Form

***REQUIRED after equipment use for nonprofit data and project evaluation for future needs.
Agency/Organization Name*
Agencies involved in training?*

Law EnforcementFire DepartmentsEMSFirst Responders
County here trailer was used*

BrownManitowocKewauneeOcontoDoorMarinetteFlorenceother
Contact:*

First NameLast Name
Phone Number*

Area CodePhone Number
Address where trailer is used*

Street Address

Street Address Line 2

CityState

Zip Code
Number of total students reached?*
Number of instructors used? *
Skills taught with manikins?

AirwayChest sealTourniquet or bleeding controlWound PackingTactical MovementNoneOther
Number of Manikins used?*

123456 or moreNone
Where SIRT laser training guns used?*

YESNOPlastic or rubber pistols only
Was any equipment damaged prior to your training?*

NOYESIF YES, please describe issue found in detail.
Comments
Date

MonthDayYear
Should be Empty: