Utilization Reporting

Prior to leaving the center, please confirm:

Manikin is off
Manikin's computer is off
Manikin is clean (no tape or tape residue)
Manikin IV bag is empty
All equipment is placed back in supply room

First name

Last name

Email address

Date

Instructor name

Account/Class

Total number of learners

Scenario name

Room numbers utilized

Total scenario time

Total report time

Total time for other categories (breaks, etc.)

Total debrief time

Total Didactic Portion time

Total deliberate practice time

Total time for other categories (breaks, etc.)

Total time in center (sum of above times)

Setup/Teardown time