FAST Exam Ultrasound Views Checklist Form
Document and verify completion of each critical step in the FAST exam workflow.
Examiner Name
*
First Name
Last Name
Date of Exam
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Right Upper Quadrant (RUQ) View
*
Completed
Not Performed
Inconclusive
Left Upper Quadrant (LUQ) View
*
Completed
Not Performed
Inconclusive
Pelvic (Suprapubic) View
*
Completed
Not Performed
Inconclusive
Pericardial View
*
Completed
Not Performed
Inconclusive
Findings Summary Table
Rows
Free Fluid Present
Adequate View
RUQ
1
2
LUQ
3
4
Pelvis
5
6
Pericardium
7
8
Other Views Performed (select all that apply)
Right Thoracic
Left Thoracic
Other
Comments / Additional Notes
Submit
Should be Empty: