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
MM
/
DD
/
YYYY
Shift start time *
Note: This is the time that you are actually in service, it is not the same thing as UPD arrival time
Time
:
Shift end time *
Note: This is the time that you are officially out of service
Time
:
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.
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