VIRGINIA BEACH
DEPARTMENT OF EMERGENCY MEDICAL SERVICES
DUTY FIELD COMMANDER (EMS-5) TEAM

INTERNSHIP RELEASE CHECKLIST

for Intern: ___________________________________________

I, the EMS-5 team captain, hereby certify that I am in receipt of the following properly completed documents:

Requirement
Duty Field Commander Application  
Application Approval Record  
Equipment Familiarity Checklist  
Indoctrination Checklist  
Staff Orientation Checklist  
Preceptor's initial Shift Evaluation  
Preceptor's final Shift Evaluation  
Other Shift Evaluations  

Furthermore, I concur that the Intern is fit for release as a Duty Field Commander (EMS-5).

Captain: ___________________________     Date: _____________________________

Captain's post-completion procedure:

  1. Attach listed documents to this checklist.

  2. Submit this checklist, with attachments, to the EMS Director's Administrative Assistant for deposit into the Intern's departmental personnel file.

EMS Director Administrative Assistant:

Please arrange for the above-listed intern to receive an EMS-5 ID card. 

$Id: release-checklist.htm 123 2001-09-07 22:54:44Z kevinanlipscomb $