Equipment Request Form
What is the best phone number to contact you?
What is the best e-mail address to contact you?
For which date do you need this equipment?
When will you require this equipment?
When will you return this equipment?
How many learners are expected to be handling the equipment?
Which skill trainer are you looking to loan?
Airway Mgmt - Adult
Airway Mgmt - Infant
Airway Mgmt - Newborn (Pierre Robin sequence)
Arterial Stick Arm - Adult
Arterial Train Arm - Infant
B.I.G. Bone Injection Trainer - Pediatric
Blue Phantom Central Line Man
Branched 4-Vessel Ultrasound Training Block Model
Breast Biopsy Ultrasound Training Model
Breast Probe Model
Central Line Man
Common Bile Duct Exploration Model
Ear Examination Simulator
Ectopic Pregnancy Transvaginal Ultrasound Training Model
Eye Examination Simulator
E.Z. I.O. Trainer
FAST Real-time Ultrasound Training Model
Femoral Central Line Placement Trainer
GYN Examination Simulator
Infant Circumcision Training Kit
Intravenous Arm Simulator - Adult
Intravenous Arm Simulator - Pediatric
Laptrainer with Simulvision
Lumbar Puncture Simulator - Adult
Lumbar Puncture Simulator - Pediatric
Male/Female Catheterization Simulator
Mr. Hurt Head Trauma Simulator
Nickie Medical Training Doll
Nita Newborn Vascular Access
Prostate Exam Simulator
Simbionix GI-BRONCH Mentor System
Storz GEM Trainer
Ultrasound-compatible Arthrocentesis Model
Ultrasound-compatible Paracentesis Model
Visual Tactile Breast Examination Simulator
Wound Care Model
I have completed training for this skill trainer(s) and understand how to use and maintain this equipment. I will supervise utilization of this skill trainer(s) during the course. I will inform PSI staff about any noted damages to the skill trainer.
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