EMT Patient Head-to-Toe Assessment Checklist Form
Complete this checklist to document your patient’s head-to-toe assessment findings during EMT care.
Patient Reference (Initials or Incident Number)
*
Airway and Breathing
*
Clear and adequate
Obstructed/Compromised
Level of Consciousness (AVPU Scale)
*
Alert
Verbal
Pain
Unresponsive
Head and Neck Findings
*
Normal
Bleeding
Deformity
Swelling
Other
Chest Assessment
*
Normal
Abnormal breath sounds
Pain
Deformity
Other
Abdomen Assessment
*
Normal
Tenderness
Rigidity
Distension
Other
Pelvis Assessment
*
Normal
Instability
Pain
Deformity
Other
Extremities Assessment
*
Normal
Deformity
Bleeding
Swelling
Other
Back and Spine Assessment
*
Normal
Tenderness
Deformity
Pain
Other
Skin Assessment
*
Normal
Pale
Cyanotic
Diaphoretic
Other
Submit Assessment
Should be Empty: