HFNC – Host Hospital Checklist for Sending and Receiving Provincial High Flow Nasal Cannula System (Nov 22)
2023 | Forms
Host hospital is required to complete this form and retain it for the record before sending/receiving HFNC
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HFNC Requesting Hospital Checklist for Sending and Receiving Provincial High Flow Nasal Cannula System (Nov 22)
2023 | Forms
Requesting hospital is required to complete this form and submit as instructed before the release of HFNC from Provincial Stockpile
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Host Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2023 | Forms
The Host Hospital is required to complete this form and retain it for their records before sending/receiving Ventilator Device(s).
Host Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2023 | Forms
The Host Hospital is required to complete this form and retain it for their records before sending/receiving Ventilator Device(s).
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Index Hospital SBAR Form (PDF)
2023 | Forms
To be completed by the Index Hospital’s critical care team (critical care manager, director or other delegate) and provided to the Hospital CEO/senior delegate prior to the Moderate Surge preamble call organized by CritiCall Ontario. The SBAR Tool provides a consistent method of reporting situations, which require escalation.
Index Hospital SBAR Form (Word)
2023 | Forms
To be completed by the Index Hospital’s critical care team (critical care manager, director or other delegate) and provided to the Hospital CEO/senior delegate prior to the Moderate Surge preamble call organized by CritiCall Ontario. The SBAR Tool provides a consistent method of reporting situations, which require escalation.
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Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2023 | Forms
The Requesting Hospital is required to complete this form and retain it for their records before receiving/returning Ventilator Device(s).
Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2023 | Forms
The Requesting Hospital is required to complete this form and retain it for their records before receiving/returning Ventilator Device(s).
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Ventilator and HFNC Allocation Sign Back – April 2023
2023 | Forms
The Requesting Hospital is required to complete this form and submit as instructed before the release of a ventilator or HFNC from the Ventilator Stockpile.
Service Inventory Change Request Form (June 2021)
2021 | Forms
This form is to be completed by critical care units that are reporting substantive changes to their hospital’s critical care capacity information.
CCIS Data Request Form (For Research)
2020 | Forms
This form must be completed in full by any individual or organization requesting access to data from the Critical Care Information System (CCIS) for research purposes
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CCIS Data Request Form (Not for Research)
2020 | Forms
This form must be completed in full by any individual or organization requesting access to data from the Critical Care Information System (CCIS).
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