Critical Incident Performance Evaluation Form
Use this form to evaluate performance during a critical incident, document key incident details, and record reviewer feedback. Critical Incident Performance Evaluation Form.
Incident Details
Incident date and time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident location
Incident type/category
Please Select
Safety
Security
Operational
Communications
Other
Brief incident summary
*
Responder and Context
Evaluator Name
*
Responder/Team Being Evaluated
*
Role or Department
Incident Severity Level
Please Select
Low
Moderate
High
Critical
Performance Evaluation
Overall Performance Rating
*
1
2
3
4
5
Response Effectiveness Score
*
1
2
3
4
5
Communication and Coordination Score
*
1
2
3
4
5
Strengths and Improvement Notes
Review Outcome
Follow-up action required?
Yes
No
Reviewer final comments
*
Submit Critical Incident Performance Evaluation Form
Should be Empty: