ALS Drill Evaluation Checklist
Use this checklist to assess performance during Advanced Life Support (ALS) training drills. Please complete all sections for a thorough evaluation.
Evaluator Name
*
First Name
Last Name
Participant(s) Name(s)
*
Date and Time of Drill
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Scenario Type
*
Please Select
Cardiac Arrest
Respiratory Arrest
Trauma
Other
Critical Actions Performed
*
Rows
Not Performed
Partially Performed
Performed Well
Scene Safety Checked
1
2
3
Initial Assessment Completed
4
5
6
Airway Management
7
8
9
CPR Initiated
10
11
12
Defibrillation (if indicated)
13
14
15
Medication Administration
16
17
18
Reassessment Performed
19
20
21
Team Roles Assignment
*
Rows
Not Assigned
Assigned Late
Assigned Timely
Team Leader
22
23
24
Airway
25
26
27
Compressions
28
29
30
Medications
31
32
33
Recorder
34
35
36
Communication and Leadership
*
1
2
3
4
5
Equipment Use Checklist
Defibrillator Used Correctly
Airway Devices Available
IV/IO Access Established
Emergency Medications Prepared
Overall Performance
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Additional Comments / Observations
Evaluator Signature
*
Submit Evaluation
Submit Evaluation
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