DA Form 7595-6-1 Implement Suicide Prevention Measures

DA Form 7595-6-1 - also known as the "Implement Suicide Prevention Measures" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 7595-6-1 - was last revised on May 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-6-1 below or request a copy through the chain of command.

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IMPLEMENT SUICIDE PREVENTION MEASURES
For use of this form see TC 8-800; the proponent agency is TRADOC.
VI
TABLE:
STP 8-68W13-SM-TG, Task: 081-831-9018.
REFERENCE:
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
S
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 a patient demonstrating possible suicidal behavior. Implement suicide preventive measures to assist this patient.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Gathered information on risk factors about the patient, if time permits.
b. Minimized possibility of self-harm.
c. Got professional help- went with the Soldier or sent the Soldier with an escort.
d. Did not cause further injury to the patient.
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.
DA FORM 7595-6-1, MAY 2014
APD LC v1.00
IMPLEMENT SUICIDE PREVENTION MEASURES
For use of this form see TC 8-800; the proponent agency is TRADOC.
VI
TABLE:
STP 8-68W13-SM-TG, Task: 081-831-9018.
REFERENCE:
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
S
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 a patient demonstrating possible suicidal behavior. Implement suicide preventive measures to assist this patient.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Gathered information on risk factors about the patient, if time permits.
b. Minimized possibility of self-harm.
c. Got professional help- went with the Soldier or sent the Soldier with an escort.
d. Did not cause further injury to the patient.
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.
DA FORM 7595-6-1, MAY 2014
APD LC v1.00

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