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Request for use of Simulation Space

Does the course meet any of the following criteria? (Choose all that apply) * Required

Hospital/Departmental Sponsorship

Patient Safety Risk Mitigation

Emergency Corrective Action/Reported Adverse Event

Essential Workforce Training/Testing

Expected Impact of Clinical Practice

Expected Patient Care Impact

JEDI Component

Revenue Generation

Other

If simulation: scenario-based option is chosen above, please click here for fillable scenario PDF

Requested Location (choose all that apply) * Required

Multipurpose Room

Skills Arcade

Videoconference Room

Debrief Room

ICU/Patient Room

Operating Room

Requested simulation center support (choose all that apply) * Required

Audio visual set-up

Recording

Live view

Recording play back for debriefing

Running simulator

Embedded simulation personnel

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