EASE Online Participant Audit Form

Please check appropriate boxes and add comments as necessary.

This audit tool in this survey is based on a tool that was developed, tested, and is being shared with the Ohio Chapter, American Academy of Pediatrics by Dr. Jamie Macklin, Nationwide Children’s Hospital.

For assistance with this tool, contact Hayley Southworth at hsouthworth@ohioaap.org or 614-846-6258.

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* 1. Hospital:

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* 2. For which time period are you entering data?

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* 3. Location and Time of Audit:

Unit Name and Type:

Observer Name:

Date of Audit (DD/MM/YY):

Time of Audit:

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* 4. Age of Child:


Age of Child:	Age of Child: menu

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* 5. Is the child asleep during observation?

Yes