Healthcare Training Safety Assessment Form
Please complete this assessment to evaluate safety readiness in your healthcare training session.
Participant Name
*
First Name
Last Name
Training Session Date
*
-
Month
-
Day
Year
Date
Role in Training
*
Please Select
Trainee
Trainer
Observer
Other
How confident are you in your knowledge of safety protocols for this training?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Readiness of Personal Protective Equipment (PPE) and safety equipment
*
Rows
Available
In Good Condition
Not Applicable
Gloves
1
2
3
Masks/Respirators
4
5
6
Eye Protection
7
8
9
Gowns/Aprons
10
11
12
Other Equipment
13
14
15
Which of the following best describes your understanding of emergency procedures in this training?
*
I can confidently explain all emergency procedures.
I know most emergency procedures.
I am unsure about some procedures.
I need further training on emergency procedures.
Rate your awareness of how to report an incident or safety concern during this training.
*
1
2
3
4
5
Please list any potential safety risks you have identified for this session.
Have you received the safety briefing for this training session?
*
Yes
No
I acknowledge that I have reviewed and understand the safety protocols for this training session.
*
I acknowledge
Submit Assessment
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