Title Page

  • Shift Name

  • Call Sign

  • Conducted on

  • Observation carried out by

  • Personnel

  • Should any issues or concerns be raised a follow up must be raised against the item. To create a follow up press the ... to the right of the question

Pre Sign On

  • Start of shift checks observed?

  • Vehicle checks observed

  • Checked vehicle for damage?

  • Tyres checked adequately?

  • Tyre checks undertaken

  • Under bonnet checks

  • Lights checked

  • Emergency reponse lights and audible warnins checked

  • Clinical equipment checks observed?

  • Medical Gas levels and flow checked

  • LSU checked

  • AED / LP15 checked correctly

Observations

  • Did you observe patient interactions

  • Observations
  • Date & Time of incident

  • Age of patient

  • Sex of pt

  • Incident number

  • Lead member of staff

  • Did the crew....

  • Introduce themselves and confirm patients name?

  • Complete a primary survey?

  • Select elements not completed

  • Explain intentions and seeks consent as they assess casualty

  • Requests to relatives/onlookers are polite and reasonable

  • Treatment options are clearly explained before they are begun

  • Casualty appears happy with choices available to them

  • Ensure Consent is obtained prior to commencement of any treatment<br><br>Auditor via observation should be able to comment on whether communication with service user was of sufficient quality to ensure consent was informed<br>

  • Ensure Casualty is not unnecessarily exposed during examination

  • Ensure Examination is appropriate to history of illness/injury

  • Two sets of observations completed?

  • Ensure Immediate treatment reflects nature of injury or symptoms

  • Ensure Contraindications/possible allergy discussed prior to dispensing medicines

  • Correct swabbing technique is used when cleaning wounds

  • Communication with the casualty is continued throughout treatment

  • Where appropriate back-up has been requested

  • Manual Handling was

  • Overall patient care was compliant with the BRC scope of practice

Documentation

  • A PCR has been completed

  • Medical Model used appropriately

  • All observations documented

  • Medical and Trauma codes completed

  • Narrative is not condensed onto CAS101

  • Is the Handover signed and timed

  • Medicines Procedure has been followed and appropriately recorded on PRF

Routine Driving

  • Did you observe Routine driving?

  • Routine Driving
  • Date and time of drive

  • Drivers Name

  • Was the speed appropriate for the circumstances?

  • Did the driver adhere to traffic signs?

  • Did the driver make appropriate use of mirrors?

  • Did the driver apply the system of car control (IPSGA)

  • Was the drive safe and adhere to BRC standards?

Emergency Driving

  • Did you observe an Emergency Drive?

  • Emergency Drive
  • Date and time of drive

  • Drivers Name

  • Were exemptions claimed appropriately

  • Did the driver adhere to traffic signs?

  • Did the driver make good use of their mirrors?

  • Did the driver demonstrate the system of car control (IPSGA)

Emergency Response driving

  • Was the speed appropriate for the circumstances?

  • Were exemptions claimed appropriately

  • Following & Overtaking

  • Acts on signals from others?

  • Use signals appropriately

  • Hazard perception is

  • Progress made is

  • Approach to pedestrian crossings is

  • Actions taken whilst under Emergency Response were

  • Overall the Emergency drive was

Core Questions

Health and Safety

  • Are crew aware of their H&S responsibility?

  • Crew know how to report an accident / incident / near miss

  • Do the crew have access to the following PPE available?

  • Did the crew carry their panic alarm?

Infection Control

  • Can the crew explain when they would clean equipment?

  • Did the crew demonstrate during the observation correct infection control processes?

  • Can the crew explain when they would clean / wash their hands?

Safeguarding

  • Can the crew explain the types of abuse?

  • Can the crew explain when consent is required to make a Safeguarding referral?

  • Can the crew explain the process for reporting safeguarding?

Specific questions

  • Can the crew explain what is meant by Dignity

  • Can the crew name and explain Consent

End of Shift

  • End of Shift observed?

  • Did the crew clean all surfaces?

  • Did the crew remove clinical waste from the vehicle

  • Did the crew mop the vehicle?

  • Did the crew restock the vehicle?

  • Did the crew plug the vehicle in?

Summary

  • Date and time observations concluded

  • General Comments

  • Please sign to confirm observations have taken place

  • Crew 1

  • Crew 2

  • Observer

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.