The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

jME8FKBSCg57NXyK3P6yCPGZj22NNusbLySFLP2IavaSoVXHaQwAXddWYCmiJpE5tcppViKbIya26

Initial Employee Entry

Please complete the survey below to create an employee profile in the Penn Medicine Trauma Hours Database. Please submit only one form per employee. To update a pre-existing employee profile in the database, contact PACETraining@pennmedicine.upenn.edu.

Monthly emails containing a form to log trauma hours into the database are automatically dispersed on the first Monday of every month to employees with an active profile and valid email address in the database.

Thank you!

First Name

* must provide value

Last Name

* must provide value

Email Address

* must provide value

UPHS Hire Date

* must provide value

M-D-Y

Start date on unit

* must provide value

M-D-Y

Unit/Group

* must provide value

Has this person taken the Trauma Nurse Course (TNC)?

* must provide value

Yes

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If yes, what date did they take the TNC?

* must provide value

M-D-Y

The Nurse has 365 days (1 year) to complete the TNC from their start date on the unit. This RN completed the TNC in the following number of days after hire on the unit

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Has this person taken Advanced Cardiac Life Support (ACLS)?

* must provide value

Yes

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If yes, please enter ACLS expiration date

* must provide value

M-D-Y

Does this person have specialty certification?

* must provide value

Yes

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If yes, please select specialty certification

* must provide value

Date of certification

* must provide value

M-D-Y

50% of the nurses on this unit employed greater than 1095 days (3 years) from their start date on the unit must complete specialty certification or complete ATCN, ENPC, TNCC, or PHTLS within that same time frame. This following number of days represent the amount of time elapsed between the nurse's hire on the unit and their certification:

View equation

Still Employed on this unit?

* must provide value

Yes

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Department end date?

* must provide value

M-D-Y

Active status?

Yes

reset

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.