Field Evaluation Form

Trainee Name

First NameLast Name

Evaluator Name

First NameLast Name

Date

Level of Care

ALS Unit

BLS Unit

Tour

Is employee a paramedic upgrade?

Employee arrived on time for assigned shift.

Employee was in uniform, well groomed, and prepared with personal equipment (stethoscope, watch, penlight, etc.).

BLS Skills Performed

ALS Skills Performed

Please rate employee's knowledge of the following:

Rows	Needs Improvement	Satisfactory	Excellent
Mount Sinai Policies & Procedures
FDNY Policies & Procedures
NYC REMAC Protocols
HealthEMS
Safe Driving Practices

Areas for Improvement

Please rate employee's proficiency in the following:

Areas for Improvement

Please rate employee's competency in the following:

Rows	Needs Improvement	Satisfactory	Excellent	Not Observed
Knowledge of REMAC Protocols
Medical Assessment
Trauma Assessment
EKG Interpretation
IV Placement
IO Insertion
Medication Administration
Endotracheal Intubation
Supraglottic Airway
Narrative Writing
Med Math

Areas for Improvement

Please rate employee's behavior in the following:

Areas for Improvement

Overall Performance

1 is Worst, 5 is Best

Comments

Trainee Signature

Evaluator Signature

New Hire Field Evaluation Form