EMS Crew Evaluation Form
Use this form to evaluate EMS crew performance during a call or shift, including response, patient care, safety, teamwork, communication, and overall professionalism.
Evaluator and Incident Details
Evaluator Name
*
First Name
Middle Name
Last Name
Role / Title
*
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
EMS Crew Member Name(s) or Crew Identifier
*
Unit / Vehicle Number
*
Incident / Call Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident Type / Call Category
*
Medical
Trauma
Cardiac
Respiratory
Pediatric
Behavioral
Other
Location / Zone
*
Shift or Station
*
Performance Evaluation
Response time
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Scene size-up
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Patient assessment
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Treatment quality
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Protocol adherence
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Communication with dispatch, partners, and patient
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Teamwork
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Professionalism
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Safety practices
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Documentation quality
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Equipment readiness
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Overall performance rating
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Strengths and Improvement
Observed Strengths
Areas Needing Improvement
Notable Commendations
Corrective Coaching Recommendations
Follow-up Action Needed
*
None
Coaching
Remediation
Re-evaluation
Supervisor Follow-up
Final Review
Final comments
*
Additional notes
Final acknowledgment
*
I confirm this evaluation is complete and accurate to the best of my knowledge
Submit Evaluation
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