Tourniquet Release Record Form
Record essential details of each tourniquet release event for accurate documentation and review.
Date of Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Event
*
Name of Person Applying Tourniquet
*
Name of Person Releasing Tourniquet
*
Tourniquet Type/Model
*
Reason for Tourniquet Application
*
Time Tourniquet Applied
*
Hour Minutes
AM
PM
AM/PM Option
Time Tourniquet Released
*
Hour Minutes
AM
PM
AM/PM Option
Duration of Application (minutes)
*
Outcome Notes / Observations
Submit Record
Should be Empty: