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Shift Date *

MM

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DD

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YYYY

Time

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AM

PM

Supervisor *

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EMT *

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EMT *

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Observer

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No Shows

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Number of calls *

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Vehicle Milage at End of Shift *

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Equipment Used

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Did you plug in the suction unit and iPad at the end of your shift?

Yes

No

Other:

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Any comments (including but not limited to: faulty equipment, incidents, no shows to specific calls, last minute shift pick-ups, providers covering/going out of service etc.)

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