Legal Name:
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Location:
Date of Event:
Chirurgeon in Charge:
Was this event's workload representative of a typical event? Yes No What is your opinion of the Apprentice's:
Attentiveness/Responsiveness 5 4 3 2 1 Not Observed
Presence of Mind/Triage ability 5 4 3 2 1 Not Observed
First Aid Skills 5 4 3 2 1 Not Observed
Communication Skills 5 4 3 2 1 Not Observed
Ability to inspire confidence 5 4 3 2 1 Not Observed
"Rabid" Tendencies (Over-eager, hovering like a vulture, etc.) 5 4 3 2 1 Not Observed
Judging by today's performance would you recommend this apprentice for a warrant? Yes No
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