1-
Operational Issues: Hospital Survey
- City/Country:
- Hospital name:
- Trauma level:
- Address:
- Hospital operator telephone #:
- Date of assessment:
- Assessor:
- Primary Point of Contact (POC)
a. Name, title and position:
b. Office telephone:
c. Home telephone:
d. Cell phone:
e. Pager:
f. Fax:
g. E-mail:
- Patient admissions/information POC and telephone #:
- Security POC and telephone #:
- Emergency department
a. Location (floor, wing):
b. Number of trauma beds:
c. Trauma capacity (case load at one time):
d. POC:
e. 24 hour desk phone #
1) Primary:
2) Secondary:
3) Alternate:
f. Radio frequencies
1) Primary:
2) Secondary: