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KidSIM Simulation Session Activity Report

1.KidSIM Simulation Session Activity Report

1.Simulation Session Date(Required.)
Please enter Simulation Session Date
2.Program/Department(Required.)
3.Name of session - as per booking (ie. UIPE, PALS, GNO, etc)(Required.)
4.Was the simulation session inter-professional?(Required.)
5.Please list number of participants for each discipline (if number is zero please leave blank)(Required.)
6.What type of session took place?(Required.)
7.Site(Required.)
8.Length of session (in hours)
ie. a session that took place from 09:00-11:30 would be 2.5(Required.)
9.Number of labs running concurrently (at same time)(Required.)
10.Name of Facilitator(s):
11.Were any of the following standardized elements included in the scenario?
Check all that apply.(Required.)
12.Were there any safety concerns identified in the simulation?(Required.)
13.Simulator used? (see ankle bracelet for color and age of manikin)
Check all that apply.
14.Task trainer used?
Check all that apply.
15.Equipment used?
Check all that apply.
16.Were there any issues with mannequins or other equipment?
*Please also identify on exit checklist in the lab*(Required.)
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