Utilization Reporting

Date

Instructor name

Account/Class

Scenario name

Total number of control stations

Debrief room(s) used

Patient room(s) used

Total number of learners

Total Didactic/Deliberate practice/meeting time

Total time in center

Setup time

Teardown time

Prior to leaving, please check:

Manikin is off

Manikin computer is off

Cleaning checklist is complete

Manikin is clean (no tape or tape residue)

Manikin IV bag is empty

All equipment is placed back in supply room