Field Evaluation Form

Trainee Name*

First NameLast Name

Evaluator Name*

First NameLast Name

Date*

Date

Level of Care*

ALS Unit*

BLS Unit*

Tour*

Is employee a paramedic upgrade?*

YesNo

Employee arrived on time for assigned shift.*

YesNo

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

YesNo

BLS Skills Performed*

ALS Skills Performed*

Please rate employee's knowledge of the following:*

	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:*

	Needs Improvement	Satisfactory	Excellent	Not Observed
Knowledge of REMACProtocols
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