Foothill College
Primary Survey
Candidate Name: _________________________________________ Date: ______________________
Examiner Name and Signature: _________________________________________________________
Time Started: __________ Time Ended: __________ Points: _____/11 PASS/FAIL (Circle One)
| Points Possible | Points Awarded | |
|---|---|---|
General Impression
|
5 | |
Level of Consciousness (AVPU)
|
1 | |
| Chief complaint/ Life threats | 1 | |
| Assess and manage airway | 1 | |
| Assess and manage breathing | 1 | |
| Assess and manage circulation | 1 | |
| Identifies Priority patients | 1 | |
| Makes transport decision | 1 |
Points Possible: 13 Total Points Awarded: _______________
Critical Criteria
____ Failure to take appropriate PPE precautions
____ Failure to manage patient competently
____ Uses or orders a dangerous or inappropriate intervention
Notes: