JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PHC Simulation Booking 2024
Welcome to the PHC Simulation Booking sheet!
While we do our best to accommodate all simulation booking requests, it becomes increasingly difficult without sufficient ahead notice.
Please follow the instructions below to ensure your booking runs smoothly.
Submit your request
at least 1 week prior
to the date of the simulation
Fill out all
required questions
, and add any additional details or comments to the last section
Once you have submitted your sheet,
wait for a confirmation reply from John
After booking is confirmed, be sure to
update John of any changes/cancellations
with as much notice as possible
*For
after hours bookings
(outside of Monday-Friday, 7:00am-4:00pm) please contact John (he/him) at
jbonilla@providencehealth.bc.ca
to request and coordinate*
If you have
difficulties or questions
, please contact John (he/him) at
jbonilla@providencehealth.bc.ca
.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What is the
educator's name
?
*
Your answer
Phone Number
*
Your answer
What is your
office room name/number
?
*
Your answer
Which
unit
are you booking from?
*
Emergency
ICU
Surgery
Maternity
Urban Health
Cardiology
Anesthesia
Resp. Therapy
Medicine
Renal Inpatient
CICU
CSICU
Cath Lab
Critical Care
HAU
OR
Radiology
Nursing GO
PPO
UBC
Healthy Heart Clinic
Mental Health
Physiotherapy
Other:
Which
location
are you booking for?
*
St. Paul's Hospital
Mount St. Joseph's Hospital
Off site
Which
simulator
will you need?
*
SimMan 3G PLUS (+ Instructor's PC, Patient Monitor, and Mouse) *can use live pads*
SimMan 3G (+ Instructor's PC, Patient Monitor, Defib. Cable, and Mouse)
SimMom (+ Instructor's PC, Patient Monitor, and Compressor)
MegaCode Kid (+ SimPad, and Patient Monitor)
Resusci Anne (+ SimPad, Patient Monitor, and Defib. Cable)
Resusci Anne - Torso Only (+ SimPad) (For CPR/Ventilations)
Little Anne QCPR (+ SimPad)
Little Anne Doll - Torso Only (Low Fidelity, No Electronics)
ECMO Simulator
Practice/Task Training Arm
Other:
Please indicate if you need
fluids
to be added to the simulator (eg, simulator blood/tears)
Your answer
What
date
are you booking for?
*For
after hours bookings
(outside of Monday-Friday, 7:00am-4:00pm) please contact John (he/him) at
jbonilla@providencehealth.bc.ca
to request and coordinate*
*
Choose
April 25, 2024 (Thursday)
April 26, 2024 (Friday)
April 29, 2024 (Monday)
April 30, 2024 (Tuesday)
May 1, 2024 (Wednesday)
May 2, 2024 (Thursday) This day is Blocked for CC
May 3, 2024 (Friday) This day is Blocked for CC
May 6, 2024 (Monday)
May 7, 2024 (Tuesday)
May 8, 2024 (Wednesday)
May 9, 2024 (Thursday) This day is Blocked for CC
May 10, 2024 (Friday) This day is Blocked for CC
May 13, 2024 (Monday)
May 14, 2024 (Tuesday)
May 15, 2024 (Wednesday)
May 16, 2024 (Thursday)
May 17, 2024 (Friday)
May 21, 2024 (Tuesday)
May 22, 2024 (Wednesday)
May 23, 2024 (Thursday)
May 24, 2024 (Friday)
May 27, 2024 (Monday)
May 28, 2024 (Tuesday)
May 29, 2024 (Wednesday)
May 30, 2024 (Thursday)
May 31, 2024 (Friday)
June 3, 2024 (Monday)
June 4 2024 (Tuesday)
June 5, 2024 (Wednesday)
June 6, 2024 (Thursday)
June 7, 2024 (Friday)
June 10, 2024 (Monday)
June 11, 2024 (Tuesday)
June 12, 2024 (Wednesday)
June 13, 2024 (Thursday)
June 14, 2024 (Friday)
June 17, 2024 (Monday)
June 18, 2024 (Tuesday)
June 19, 2024 (Wednesday)
June 20, 2024 (Thursday)
June 21, 2024 (Friday)
June 24, 2024 (Monday)
June 25, 2024 (Tuesday)
June 26, 2024 (Wednesday)
June 27, 2024 (Thursday)
June 28, 2024 (Friday)
July 1, 2024 (Monday)
July 2, 2024 (Tuesday)
July 3, 2024 (Wednesday)
July 4, 2024 (Thursday)
July 5, 2024 (Friday)
July 8, 2024 (Monday)
July 9, 2024 (Tuesday)
July 10, 2024 (Wednesday)
July 11, 2024 (Thursday)
July 12, 2024 (Friday)
July 15, 2024 (Monday)
July 16, 2024 (Tuesday)
July 17, 2024 (Wednesday)
July 18, 2024 (Thursday)
July 19, 2024 (Friday)
July 22, 2024 (Monday)
July 23, 2024 (Tuesday)
July 24, 2024 (Wednesday)
July 25, 2024 (Thursday)
July 26, 2024 (Friday)
July 29, 2024 (Monday)
July 30, 2024 (Tuesday)
July 31, 2024 (Wednesday)
August 1, 2024 (Thursday)
August 2, 2024 (Friday)
August 6, 2024 (Tuesday)
August 7, 2024 (Wednesday)
August 8, 2024 (Thursday)
August 9, 2024 (Friday)
August 12, 2024 (Monday)
August 13, 2024 (Tuesday)
August 14, 2024 (Wednesday)
August 15, 2024 (Thursday)
August 16, 2024 (Friday)
August 19, 2024 (Monday)
August 20, 2024 (Tuesday)
August 21, 2024 (Wednesday)
August 22, 2024 (Thursday)
August 23, 2024 (Friday)
August 26, 2024 (Monday)
August 27, 2024 (Tuesday)
August 28, 2024 (Wednesday)
August 29, 2024 (Thursday)
August 30, 2024 (Friday)
September 3, 2024 (Tuesday)
September 4, 2024 (Wednesday)
September 5, 2024 (Thursday)
September 6, 2024 (Friday)
September 9, 2024 (Monday)
September 10, 2024 (Tuesday)
September 11, 2024 (Wednesday)
September 12, 2024 (Thursday)
September 13, 2024 (Friday)
September 16, 2024 (Monday)
September 17, 2024 (Tuesday)
September 18, 2024 (Wednesday)
September 19, 2024 (Thursday)
September 20, 2024 (Friday)
September 23, 2024 (Monday)
September 24, 2024 (Tuesday)
September 25, 2024 (Wednesday)
September 26, 2024 (Thursday)
September 27, 2024 (Friday)
October 1, 2024 (Tuesday)
October 2, 2024 (Wednesday)
October 3, 2024 (Thursday)
October 4, 2024 (Friday)
October 7, 2024 ( Monday)
October 8, 2024 (Tuesday)
October 9, 2024 (Wednesday)
October 10, 2024 (Thursday)
October 11, 2024 (Friday)
October 15, 2024 (Tuesday)
October 16, 2024 (Wednesday)
October 17, 2024 (Thursday)
October 18, 2024 (Friday)
October 21, 2024 ( Monday)
October 22, 2024 (Tuesday)
October 23, 2024 (Wednesday)
October 24, 2024 (Thursday)
October 25, 2024 (Friday)
October 28, 2024 ( Monday)
October 29, 2024 (Tuesday)
October 30, 2024 (Wednesday)
October 31, 2024 (Thursday)
November 1, 2024 (Friday)
November 4, 2024 (Monday)
November 5, 2024 (Tuesday)
November 6, 2024 (Wednesday)
November 7, 2024 (Thursday)
November 8, 2024 (Friday)
November 12, 2024 (Tuesday)
November 13, 2024 (Wednesday)
November 14, 2024 (Thursday)
November 15, 2024 (Friday)
November 18, 2024 (Monday)
November 19, 2024 (Tuesday)
November 20, 2024 (Wednesday)
November 21, 2024 (Thursday)
November 22, 2024 (Friday)
November 25, 2024 (Monday)
November 26, 2024 (Tuesday)
November 27, 2024 (Wednesday)
November 28, 2024 (Thursday)
November 29, 2024 (Friday)
December 2, 2024 (Monday)
December 3, 2024 (Tuesday)
December 4, 2024 (Wednesday)
December 5, 2024 (Thursday)
December 6, 2024 (Friday)
December 9, 2024 (Monday)
December 10, 2024 (Tuesday)
December 11, 2024 (Wednesday)
December 12, 2024 (Thursday)
December 13, 2024 (Friday)
December 16, 2024 (Monday)
December 17, 2024 (Tuesday)
December 18, 2024 (Wednesday)
December 19, 2024 (Thursday)
December 20, 2024 (Friday)
December 23, 2024 (Monday)
December 24, 2024 (Tuesday)
December 26, 2024 (Thursday)
December 27, 2024 (Friday)
December 30, 2024 (Monday)
December 31, 2024 (Tuesday)
What is the
start time
? (Note: keep in mind set up, transport, and travel time. John generally recommends at least 1 hour for set up)
*
Choose
7:00 AM
7:30 AM
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
What is the
end time
?
*
Choose
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
Where will the simulation be held?
Provide room number, floor, building and site
*
Your answer
How much
technical support
will you be requiring?
*
Full technical support
Equipment delivery and pick-up
Equipment set up/take down only
Equipment delivery only
Training required (for new educators)
No support required
Required
What is the expected
number of participants
?
*
Your answer
Paste a
link for case/scenario
to be programmed.
Your answer
What is the
sim type
you are booking? (e.g. Mock code blue)
*
Your answer
Do you need any
additional equipment
?
Your answer
Any
additional comments
?
Your answer
Please ensure the attendance sheet is filled out and returned back to John after the simulation session. The same can be found here
https://sim.providencehealthcare.org/services/book-a-sim/
*You hereby acknowledge that you will submit the participant sign in sheet to John once the session has been completed.
*
Yes
Required
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms