EMT Secondary Patient Assessment Checklist Form
Complete this EMT Secondary Patient Assessment Checklist Form to document structured findings during a secondary patient assessment. Use the checklist and observations fields to ensure thorough and consistent evaluation.
Level of Consciousness (AVPU)
*
Alert
Verbal
Pain
Unresponsive
Airway Status
*
Clear
Obstructed
Partially Obstructed
Breathing Quality
*
Normal
Labored
Shallow
Noisy
Circulation (Pulse Quality)
*
Normal
Weak
Irregular
Absent
Skin Signs
*
Normal
Pale
Cool
Clammy
Flushed
Cyanotic
Rapid Head-to-Toe Assessment Findings
*
No Abnormalities
Bleeding
Deformities
Swelling
Tenderness
Other
Vital Signs (Enter Most Recent Values)
*
Rows
Value
Pulse (bpm)
Respiratory Rate (per min)
Blood Pressure (mmHg)
Oxygen Saturation (%)
Temperature (°F or °C)
Allergies
*
None
Known Allergies
Medications
*
None
Current Medications
Pertinent Medical History or Observations
Submit Assessment
Should be Empty: