Sample Forms

The following links were provided by various EMS agencies, training facilities and Regional Councils to assist instructors with development of forms for their programs.

• Clinical Assessment Form
• Clinical Evaluation Form #1
• Clinical Evaluation Form #2
• Sample Forms from George Washington University
• Clinical Performance Checklist
• Student Evaluation
• Clinical Documentation Form
• Competencies and Skills Documentation Form
• Preceptor Evaluation Form
• Field Preceptorship Documentation Form
• Field Preceptor Evaluation Form
• Statement of Agreement-Agencies
• Statement of Agreement-Mutual Aid
• Subjective Student Field Preceptorship Evaluation Form