FOOTHILL COLLEGE
Candidate Name: _________________________________________ Date: ______________________
Examiner Name and Signature: _________________________________________________________
Time Started: __________ Time Ended: __________ Points: _____/12 PASS/FAIL (Circle One)
| Points Possible | Points Awarded | |
| General Impression | ||
|
5 | |
| Level of Consciousness (AVPU) | ||
|
1 | |
| Chief complaint/ Life threats | 1 | |
| Assess and manage X-Airway | 1 | |
| Assess and manage Breathing | 1 | |
| Assess and manage Circulation | 1 | |
| Assessed Disability | 1 | |
| Expose, Examine and protect from Environment | ||
| Identifies Priority patients | ||
| Makes transport decision | 1 |
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: ____________________________________________________________________________________________
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