NFPA 1006 Skills Evaluation Check Sheet - REACT

1 YesNo YesNo1234516 PassPassFailFailNFPA 1006 Skills Evaluation Check SheetSkill Sheet Identify Support Resources Student #:JPR Site Operations RandomSelects rehab areasDate:Student Name:Directions: Identify the needed support resources, given a specific type of rescue incident, so that a resource cache is managed, scene lighting is provided for the tasks to be undertaken, environmental concerns are managed, personnel rehabilitation is facilitated, and the support operation facilitates rescue operational NumberManage personnel rotationsTaskRetestIdentifies lighting resourcesIdentifies structures for shelter and thermal control optionsTracks equipment inventorsInitial TestWere all tasks completed in a SAFE manner? ( NO indicates automatic failure)Pass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Version nfpa 1006 2008 editionVersion nfpa 1006 2008 editionYesNo YesNo123416 PassPassFailFailPass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Were all tasks completed in a SAFE manner?

2 ( NO indicates automatic failure)TaskRetestGathers informationRelays informationIs able to read reference materialsInitial TestUses information gathering resourcesDirections: Size up a rescue incident, given background information and applicable reference materials, so that the type of rescue is determined, the number of victims is identified, the last reported location of all victims is established, witnesses and reporting parties are identified and interviewed, resource needs are assessed, search parameters are identified, and information required to develop an incident action plan is NumberNFPA 1006 Skills Evaluation Check SheetSkill Sheet Size Up an Incident Student #:JPR Site Operations RandomDate:Student Name:Version nfpa 1006 2008 editionVersion nfpa 1006 2008 editionYesNo YesNo12345616 PassPassFailFailDirections: Manage incident hazards, given scene control barriers, personal protective equipment, requisite equipment, and available specialized resources, so that all hazards are identified, resource application fits the operational requirements, hazard isolation is considered, risks to rescuers and victims are minimized, and rescue time constraints are taken into NumberNFPA 1006 Skills Evaluation Check SheetSkill Sheet Manage Incident Hazards Student #:JPR Site Operations RandomDate:Student Name:Places scene control barriersOperates control and mitigation equipmentTaskRetestIdentifies incident hazardsAssesses victim viability (risk benefit)Identifies resource capabilities and limitationsInitial TestUtilizes technical referencesWere all tasks completed in a SAFE manner?

3 ( NO indicates automatic failure)Pass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Version nfpa 1006 2008 editionYesNo YesNo1234567816 PassPassFailFailDirections: Manage resources in a rescue incident, given incident informatin, a means of communication, resources, tactical worksheets, personnel accountability protocol, applicable references, and standard operationg procedures, so that references are utilized, personnel are acounted for, deployed resources achieve desired objectives, incident actions are documented, rescue efforts are coordinated, the command structure is established, task assignments ar communicated and monitored, and actions are consistent with appplicable NumberNFPA 1006 Skills Evaluation Check SheetSkill Sheet Manage Resources Student #:JPR Site Operations RandomDate:Student Name:Matches resources to operational needsOperates communications equipmentTaskCommunicates in a manner so that incident objectives are metRetestCompletes tactical worksheetsUses reference materialsImplements the Incident Management SystemInitial TestEvaluate incident informationManages incident communicationsWere all tasks completed in a SAFE manner?

4 ( NO indicates automatic failure)Pass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Version nfpa 1006 2008 editionYesNo YesNo123456789 PassPassFailFailEffective communications are maintained between team membersAll rescuers safely exit the search areaPass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Persons within the search area are questioned and the info is relayed to commandStudent Name:Task NumberTaskInitial TestRetestHazards are managed effectivelyA personnel accountability system is utilized for both rescuers Search parameters are establishedSearch is systematic and thoroughDirections: Given hazard specific PPE, equipment pertinent to the search assignment, an incident location, victim(s) profile and working as a member of a search team, the candidates will conduct a thorough and systematic all tasks completed in a SAFE manner?

5 ( NO indicates automatic failure)Victim profile is established and communicatedNFPA 1006 Skills Evaluation Check SheetSKILL Sheet CONDUCT A SEARCHS tudent #:JPR Site Operations RandomSearch is expedient given the conditionsDate:Version nfpa 1006 2008 editionYesNo YesNo1234 PassPassFailFailDirections: Perform ground support operations for helicopter activities, given a rescue scenario/incident, helicopter, operational plans, PPE, requisite equipment, and available specialized resources, so that rescue personnel are aware of the operational characteristics of the aircraft and demonstrate operational proficiency in establishing and securing landing zones and communicating with aircraft personnel until the assignment is all tasks completed in a SAFE manner? ( NO indicates automatic failure)Uses appropriate PPENFPA 1006 Skills Evaluation Check SheetSKILL Sheet HELICOPTER GROUND SUPPORTS tudent #:JPR Site Operations RandomCommunicates with aircrewsDate:Student Name:Task NumberTaskInitial TestRetestLanding zone is identified, established and controlledReviews standard operating procedures for helicopter operationsPass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Version nfpa 1006 2008 editionYesNo YesNo123456 PassPassFailFailAsset and personnel tracking systems are used to assure personnel and equipment are returned to a state of readinessWere all tasks completed in a SAFE manner?

6 ( NO indicates automatic failure)Post event analysis is conductedPass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Task NumberTaskInitial TestRetestUses sound risk analysis, rescuer risk is managedScene security & control is established/continued until custody of the scene is transferred to a responsible partyNFPA 1006 Skills Evaluation Check SheetSKILL Sheet TERMINATE AN INCIDENTS tudent #:JPR Site Operations RandomData is collected and used to complete record keeping and documentationDate:Student Name:Hazards are recognized and managedDirections: Terminate a technical rescue operation, given an incident scenario, assigned resources, and site safety data, so that rescuer risk and site sefety are managed, scene security is maintained and custody transferred to a responsible party, personnel and resources are returned to a state of readiness, record keeping and documentation occur, an post event analysis is nfpa 1006 2008 editionYesNo YesNo12310 PassPassFailFailPass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Task NumberTaskInitial TestRetestWere all tasks completed in a SAFE manner?

7 ( NO indicates automatic failure)Assigns the correct triage category to victimsUtilizes Body Substance Isolation/Universal precautionsNFPA 1006 Skills Evaluation Check SheetSKILL Sheet TRIAGE VICTIMSS tudent #:JPR Victim Management MandatoryDate:Student Name:Correctly attaches triage tagsDirections: Triage victims, given triage tags and local protocol, so that rescue versus recovery factors are assessed, triage decisions reflect resource capabilities, severity of injuries is determined, and victim care and rescue priorities are established in accordance with local nfpa 1006 2008 editionYesNo YesNo123456 PassPassFailFailPass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:TaskInitial TestRetestEffectively operates/executes removal system, equipment or methodWere all tasks completed in a SAFE manner? ( NO indicates automatic failure)Effectively secures patient to the selected transport equipmentEffectively communicates to the other team membersEliminates undue further injuries to the patientSelects proper transport equipment for specific rescue environmentDirections: Move a victim in a low angle environment, given victim transport equipment, litters, other specialized equipment, and victim removal systems specific to the rescue environment, so that the victim is moved without undue further injuries, risks to rescuers are minimized, the integrity of the victim's securement within the transfer device is established and maintained, the means of attachment to the rope rescue system is maintained, and the victim is removed from the 1006 Skills Evaluation Check SheetSKILL Sheet LOW ANGLE VICTIM MOVEMENT Student #:JPR Victim Management MandatoryDate:Student Name.

8 Task NumberVersion nfpa 1006 2008 editionYesNo YesNo12 PassPassFailFailGives an effective verbal report of victim condition and history to EMS providerDirections: Transfer a victim to emergency medical services (EMS), given local medical protocols, so that all pertinent information is passed from rescuer to EMS provider, and the victim can be transported to a medical care 1006 Skills Evaluation Check SheetSKILL Sheet TRANSFER VICTIM TO EMS Student #:JPR Victim Management MandatoryDate:Student Name:Task NumberTaskInitial TestRetestWere all tasks completed in a SAFE manner? ( NO indicates automatic failure)Completes reports and checklistsPass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Version nfpa 1006 2008 editionYesNo YesNo123456 PassPassFailFailSelects and uses tools specific to the taskWere all tasks completed in a SAFE manner?

9 ( NO indicates automatic failure)Pass/Fail Criteria: Any "No" constitutes a failure of the Signature (retest):Evaluator Signature (initial):Evaluator Comments:Task NumberTaskInitial TestRetestEvaluates operational readiness of PPEC ompletes logs and recordsNFPA 1006 Skills Evaluation Check SheetSKILL Sheet PPE INSPECTION AND MAINTENANCES tudent #:JPR Maintenance RandomUses cleaning equipment, supplies, and reference materialsDate:Student Name:Identifies wear and damage indicators for PPED irections: Given clothing or equipment for the protection of the rescuers, cleaning and sanitation supplies, maintenance/inspection logs or records, required tools and guidelines as specified by the manufacturer, the candidate will inspect and maintain the hazard specific personal protective equipment (PPE)used during technical rescue operations, so that the equipment is determined to be service ready or defective and removed from service.

10 Version nfpa 1006 2008 editionYesNo YesNo12345 PassPassFailFailNFPA 1006 Skills Evaluation Check SheetSKILL Sheet RESCUE EQUIPMENT INSPECTION AND MAINTENANCES tudent #:JPR Maintenance RandomDate:Student Name:Identifies wear and damage indicators for rescue equipmentDirections: Given maintenance logs and records, tools, and resources as indicated by the manufacturers guidelines, equipment replacement protocol, and organizational SOP, the candidate will inspect and maintain rescue equipment so that the operational status of equipment is verified and documented, all components are checked for operation, deficiencies are repaired or reported as indicated by SOP, and items subject to replacement protocol are correctly disposed of and changedTask NumberTaskInitial TestRetestEvaluates operational readiness of equipmentCompletes logs and recordsSelects and uses tools specific to the taskWere all tasks completed in a SAFE manner?