DAILY PERFORMANCE

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Trainee Name*

First Last

Preceptor Name*

First Last

Date*

EVALUATION

Appearance

Appearance Unsatisfactory, Why?

Overall Attitude

Overall Attitude Unsatisfactory, Why?

Interpersonal Skill (patient, facility, team member)

Interpersonal Skill Unsatisfactory, Why?

Medical Knowledge

Medical Knowledge Unsatisfactory, Why?

Assessment Skills

Assessment Skills Unsatisfactory, Why?

Treatment Skills

Treatment Skills Unsatisfactory, Why?

Problem Solving Skills

Problem Solving Skills Unsatisfactory, Why?

Safety/Situational Awareness

Safety/Situational Awareness Unsatisfactory, Why?

Scene Control

Scene Control Unsatisfactory, Why?

Vehicle Operations

Vehicle Operations Unsatisfactory, Why?

Area/Common Facilities Familiarization

Area/Common Facilities Familiarization Unsatisfactory, Why?

Routes of Travel in Norwich

Routes of Travel in Norwich Unsatisfactory, Why?

Routes of Travel in New London

Routes of Travel in New London Unsatisfactory, Why?

Routes of Travel for Paramedic Intercept

Routes of Travel for Paramedic Intercept Unsatisfactory, Why?

General Company Operations

General Company Operations Unsatisfactory, Why?

Radio Etiquette

Radio Etiquette Unsatisfactory, Why?

Feedback Acceptance

Feedback Acceptance Unsatisfactory, Why?

EHR Proficiency

EHR Proficiency Unsatisfactory, Why?

Equipment Familiarization

Equipment Familiarization Unsatisfactory, Why?

Trainee Notified By FTO of Concerns During Training Shift*

Yes

Other Comments

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