Off-SZN Lifeguard Evaluation

• Conducted on

  Date

• Prepared by

Guard Evaluation

• Guard being evaluated

  Select

• Is the Guard on stand?

  Yes

  No

  N/A

• Guard is wearing rescue tube and has appropriate equipment (whistle, hip pack, pocket mask, rescue tube, lanyard, swimsuit & hip pack) and approved uniform

  Yes

  No

  N/A

• Guard is sitting/standing upright and has both feet shoulder width apart and planted

  Yes

  No

  N/A

• Guard appears alert

  Yes

  No

  N/A

• Focused on primary responsibilities with no distractions

  Yes

  No

  N/A

• Head moves through entire zone at reasonable rate

  Yes

  No

  N/A

• Constantly watches entire zone

  Yes

  No

  N/A

• Follows 5 minute sit-stand-sit procedure

  Yes

  No

  N/A

• Does not turn back to part of zone

  Yes

  No

  N/A

• Communication with incoming/outgoing guard while rotating and maintains proper scanning

  Yes

  No

  N/A

• Clear and definite transfer of zone

  Yes

  No

  N/A

• No wasted time during rotation

  Yes

  No

  N/A

• Is the guard roving/in the office?

  Yes

  No

  N/A

• Roving correctly and efficiently while scanning their zone

  Yes

  No

  N/A

• Guard is wearing approved uniform

  Yes

  No

  N/A

• Professional on the phone?

  Yes

  No

  N/A

• Answers Active/registration questions correctly

  Yes

  No

  N/A

• Guard is professional in the office

  Yes

  No

  N/A

• Observation End Time

  Date

• Signature of Evaluated Guard

  Sign

• Printed Name

  Select

• Signed off opening and closing procedures

  Yes

  No

  N/A

• Lap swim binder paperwork is complete and up to date (counts and chem checks)

  Yes

  No

  N/A

• Observed sanitation steps

  Yes

  No

  N/A

• Pool deck is clean

  Yes

  No

  N/A

• Bathrooms are clean

  Yes

  No

  N/A

Scenario Description

• Please describe the scenario in detail (who, what, when, where, how)

• Name of Recusing Guard

  Select

• Backup Guards

  Select

• Location of event within facility

  Drawing

Evaluation of Care

• Did the initial rescuer recognize the victim within 30 seconds?

  Yes

  No

  N/A

• How long did it take to recognize the victim (seconds)

• Did the victim receive ventilations within the first 1min 30 sec?

  Yes

  No

  N/A

• Did the victim receive the AED within the first 1min 30 sec?

  Yes

  No

  N/A

• Time to AED (seconds)

• Time to AED applied (seconds)

• Was someone assigned to call 911 or relay info to cashier?

  Yes

  No

  N/A

SWIFT Scores

• I would categorize this SWIFT as:

  Pass

  Fail

  N/A

• Rescuing Guard Score

  Pass

  Fail

  N/A

• Backup Guard 1 Score

  Pass

  Fail

  N/A

• Backup Guard 2 Score

  Pass

  Fail

  N/A

• Backup Guard 3 Score

  Pass

  Fail

  N/A

• Backup Guard 4 Score

  Pass

  Fail

  N/A

• Backup Guard 5 Score

  Pass

  Fail

  N/A

• Team Score

  Pass

  Fail

  N/A

• Additional Notes

• Name of Evaluator

  Select

• Signature of Evaluator

  Sign