DA Form 7595-2-5 "Set up an Oxygen Tank"

What Is DA Form 7595-2-5?

This is a military form that was released by the U.S. Department of the Army (DA) on May 1, 2014. The form, often mistakenly referred to as the DD Form 7595-2-5, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

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Download DA Form 7595-2-5 "Set up an Oxygen Tank"

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SET UP AN OXYGEN TANK
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W13-SM-TG, Tasks: 081-833-0098, Set up an Oxygen Tank;
REFERENCE:
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification IAW AR
PRINCIPAL PURPOSE:
40-68, AR 220-1 and AR 350-1.
Used by Unit personnel to monitor training. The DOD "Blanket Routine uses" set forth at the beginning of the Army's
ROUTINE USES:
compilation of system of records notices may apply to this system.
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in processing
DISCLOSURE:
applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter a patient with difficulty breathing. You must assemble an oxygen system for the patient with an
appropriate delivery device.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Obtained the necessary equipment.
b. Secured the oxygen cylinder.
c. Removed the cylinder valve cap.
d. Used either the hand wheel or a non-sparking wrench to "crack" the cylinder to flush out debris.
e. Attached the regulator/flow meter to the cylinder.
f. Filled the humidifier bottle to the level indicated with sterile water.
g. Attached the humidifier to the flow meter.
h. Posted warning signs.
i. Documented/reported completion of the procedure.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. First Evaluator
8. Start Time
9. Stop Time
10. Retest Evaluator
12. Stop Time
13. Final Evaluator
11. Start Time
14. Evaluator's Comments
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyrighted material from National
Registry of Emergency Medical Technicians, Inc. (NREMT), skill sheets ©2011, this form has neither been prepared nor approved by NREMT. Use is
restricted to guidelines contained in the Preface to TC 8-800.
DA FORM 7595-2-5, MAY 2014
APD LC v1.00
SET UP AN OXYGEN TANK
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W13-SM-TG, Tasks: 081-833-0098, Set up an Oxygen Tank;
REFERENCE:
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification IAW AR
PRINCIPAL PURPOSE:
40-68, AR 220-1 and AR 350-1.
Used by Unit personnel to monitor training. The DOD "Blanket Routine uses" set forth at the beginning of the Army's
ROUTINE USES:
compilation of system of records notices may apply to this system.
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in processing
DISCLOSURE:
applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter a patient with difficulty breathing. You must assemble an oxygen system for the patient with an
appropriate delivery device.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Obtained the necessary equipment.
b. Secured the oxygen cylinder.
c. Removed the cylinder valve cap.
d. Used either the hand wheel or a non-sparking wrench to "crack" the cylinder to flush out debris.
e. Attached the regulator/flow meter to the cylinder.
f. Filled the humidifier bottle to the level indicated with sterile water.
g. Attached the humidifier to the flow meter.
h. Posted warning signs.
i. Documented/reported completion of the procedure.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. First Evaluator
8. Start Time
9. Stop Time
10. Retest Evaluator
12. Stop Time
13. Final Evaluator
11. Start Time
14. Evaluator's Comments
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyrighted material from National
Registry of Emergency Medical Technicians, Inc. (NREMT), skill sheets ©2011, this form has neither been prepared nor approved by NREMT. Use is
restricted to guidelines contained in the Preface to TC 8-800.
DA FORM 7595-2-5, MAY 2014
APD LC v1.00