CPMU - Active Member Evaluation Form
Crew Chiefs and Crew Chief Trainees should complete this form for all Active members on their tours.
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Active Member *
Evaluator *
Your Email *
Tour Date *
Service Venue *
Number of Patient Contacts *
Please rate the member on the following criteria: *
Poorly
Average
Good
Exceptionally
N/A
Skills Competency: How well does the EMT perform basic EMT techniques?
Clinical Judgment: How well does the EMT appropriately apply his judgment to clinical/patient situations?
Knowledge of Protocols: How familiar is the EMT with state, city, and unit policies?
Trainee Participation: Rate the EMT’s level of participation and role in providing patient care.
Patient Interaction: How well did the EMT interact with patients?
Crew Interaction: How well did the EMT interact with other members of CPMU?
Community Interaction: How well did the EMT interact with other Members of Service, Central Park employees, volunteers & patrons?
Level of Confidence: From your observations, describe the outward demeanor and level of confidence shown by the EMT’s own abilities?
Overall Performance of the Member
Based on your experience with the active member, do you believe they would be competent as an Acting Crew Chief? *
Briefly provide comments about the active member:
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This form was created inside of Central Park Medical Unit, Inc..