CCIS Data Request Form (For Research)
2020 | Forms
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Our repository of critical care reports, guidance, toolkits, forms & educational materials.
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CCIS Data Request Form (Not for Research)
2020 | Forms
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Host Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2020 | Forms
Checklist for Sending/Receiving Ventilators (Form Two) is required to ensure that all associated equipment (including consumables) required to safely operate the ventilator(s) is accounted for, and to document the physical condition of the ventilator(s) prior to release. The Host Hospital must complete the checklist prior to shipping the ventilator(s) to the Requesting Hospital and upon receipt of the ventilators back from the Requesting Hospital. Both the Host Hospital and Requesting Hospital should retain copies of these completed checklists for their records, and to provide if requested by CCSO or MOH.
Host Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2020 | Forms
Checklist for Sending/Receiving Ventilators (Form Two) is required to ensure that all associated equipment (including consumables) required to safely operate the ventilator(s) is accounted for, and to document the physical condition of the ventilator(s) prior to release. The Host Hospital must complete the checklist prior to shipping the ventilator(s) to the Requesting Hospital and upon receipt of the ventilators back from the Requesting Hospital. Both the Host Hospital and Requesting Hospital should retain copies of these completed checklists for their records, and to provide if requested by CCSO or MOH.
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Partner Hospital Reporting Form (PDF)
2020 | Forms
To be completed by Partner Hospitals prior to joining the Moderate Surge teleconference (organized by CritiCall Ontario). This form has been developed to confirm resources available at the partner hospital in the event of a moderate surge.
Partner Hospital Reporting Form (Word)
2020 | Forms
To be completed by Partner Hospitals prior to joining the Moderate Surge teleconference (organized by CritiCall Ontario). This form has been developed to confirm resources available at the partner hospital in the event of a moderate surge.
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Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2020 | Forms
When accessing ventilators from the Provincial Stockpile, the Requesting Hospital is required to complete the Requesting Hospital Checklist for Sending/Receiving Ventilators (Form Three) upon receipt of the ventilator(s). Any malfunction or damage to the ventilator(s) noted while completing the checklist at the Requesting Hospital must be reported immediately to the Host Hospital Site Lead to begin discussion on how best to coordinate timely repair of the ventilator(s).
Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2020 | Forms
When accessing ventilators from the Provincial Stockpile, the Requesting Hospital is required to complete the Requesting Hospital Checklist for Sending/Receiving Ventilators (Form Three) upon receipt of the ventilator(s). Any malfunction or damage to the ventilator(s) noted while completing the checklist at the Requesting Hospital must be reported immediately to the Host Hospital Site Lead to begin discussion on how best to coordinate timely repair of the ventilator(s).
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Ventilator Stockpile Allocation Sign-Back Agreement for Requesting Hospitals
2020 | Forms
The Requesting Hospital is required to complete this form and submit as instructed before the release of a ventilator from the Provincial stockpile.
Service Inventory Change Request Form (November 2019)
2019 | Forms
This form is to be completed by critical care units that are reporting substantive changes to their hospital’s critical care capacity information.
Index Hospital SBAR Form (PDF)
2017 | 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)
2017 | 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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