DA Form 7595-5-5 Perform Manual Evacuation

DA Form 7595-5-5 - also known as the "Perform Manual Evacuation" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7595-5-5 - was last revised on May 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-5-5 down below or look it up on the Army Publishing Directorate website.

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PERFORM MANUAL EVACUATION
For use of this form see TC 8-800; the proponent agency is TRADOC.
V
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0282 Perform Manual Evacuation
PRIVACY ACT STATEMENT
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
Development.
PRINCIPAL PURPOSE:
To ensure that accomplishment of training is properly credited to the correct individual for NREMT
certification IAW AR 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
ROUTINE USES:
the Army's compilation of system of records notices may apply to this system.
DISCLOSURE:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error
in processing applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
You have multiple patients that have been stabilized and now require evacuation. Perform manual evacuation maneuvers.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Determined the appropriate extraction device or carry for the tactical situation.
b. Communicated the plan to the patient.
c. If necessary, tactically approached the patient.
d. Properly attached the appropriate extraction device or secured the patient for manual carry.
e. Extracted the patient to cover.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial 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.
APD LC v1.00
DA FORM 7595-5-5, MAY 2014
PERFORM MANUAL EVACUATION
For use of this form see TC 8-800; the proponent agency is TRADOC.
V
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0282 Perform Manual Evacuation
PRIVACY ACT STATEMENT
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
Development.
PRINCIPAL PURPOSE:
To ensure that accomplishment of training is properly credited to the correct individual for NREMT
certification IAW AR 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
ROUTINE USES:
the Army's compilation of system of records notices may apply to this system.
DISCLOSURE:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error
in processing applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
You have multiple patients that have been stabilized and now require evacuation. Perform manual evacuation maneuvers.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Determined the appropriate extraction device or carry for the tactical situation.
b. Communicated the plan to the patient.
c. If necessary, tactically approached the patient.
d. Properly attached the appropriate extraction device or secured the patient for manual carry.
e. Extracted the patient to cover.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial 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.
APD LC v1.00
DA FORM 7595-5-5, MAY 2014

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