Daily Observation Report

Daily
Observation
Report
Evaluator/FTO
Trainee
Date*
MonthDayYear
Date
FTO's please review Standard Evaluation Guidelines in Trello for accurate complete of Daily Obersvation Report
Start of Shift*
1 2 3 4 5
Preparedness
Pass-on/Shift Handoff Report
Unit/Equipment Check
Driving pre-trip inspection
Equipment Operations*
1 2 3 4 5
Medical Durable Goods
Gurney Operations
Radio
Driving*
1 2 3 4 5
Mapping
Driving Ability
Backing
Vehicle placement and Exit Routes
Smooth Transport
EMS Skills and Knowledge*
1 2 3 4 5
Protocol Knowledge
Policy and Procedure Knowledge
Interventions/procedures
Patient Care*
1 2 3 4 5
Scene Safety/Awareness
Patient Interaction and Care
Patient Assessments
Scene Management
Assisting Partner
Phone/Radio Report
Transfer of Care
Documentation*
1 2 3 4 5
Elite/Report Writing Skills
Post Call Duties*
1 2 3 4 5
Return to service
Interpersonal Skills*
1 2 3 4 5
Attitude
Communication
Multi-tasking Skills
Daily Duties*
1 2 3 4 5
Cleaning
Documentation of areas that score 1 or 5 need explanation in comments. (If none write none)*
Strengths observed during shift.
Weaknesses observed during shift. (Things FTO feels employee should work on)
Recommendations to work on for next shift & Additional FTO Comments*
Trainee Comments
Was this report gone over with Trainee?*
Should be Empty:

	1	2	3	4	5
Mapping
Driving Ability
Backing
Vehicle placement and Exit Routes
Smooth Transport

	1	2	3	4	5
Protocol Knowledge
Policy and Procedure Knowledge
Interventions/procedures

	1	2	3	4	5
Scene Safety/Awareness
Patient Interaction and Care
Patient Assessments
Scene Management
Assisting Partner
Phone/Radio Report
Transfer of Care