After Action Report
Every responder needs to fill out this form after every shift. Falsifying hours will result in dismissal from the unit.
Email *
Name *
Note: If your name is not present, please contact the Operations Coordinators
Event worked: *
Name of Event: *
Name provided in the groupme
Your role during the shift *
Date *
For night shifts, use the date the shift started
Shift start time *
Note: This is the time that you are actually in service, it is not the same thing as UPD arrival time
Shift end time *
Note: This is the time that you are officially out of service
Number of hours worked *
Time between shift start time and shift end time. Round to the nearest half hour.
Number of Patients *
Number of Transports *
Has all reusable equipment been disinfected? Including but not limited to: Adult and Peds BP cuff, Stethoscope, AED, Suction, Radio, Clipboard *
If you noticed any supplies being low/out of stock, please mention it below
Additional comments/concerns
Please do not break HIPPA
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Gator Emergency Medical Response Unit. Report Abuse