Clinical Simulation Request Form

5. Purpose of request?

• Required education (e.g., safety event, system initiative, compliance or mandated training)
• General education (e.g., safety event, team training, independent skills)
• Testing (e.g., competency, assessment)
• Computerized testing
• Borrow or rent clinical simulation equipment for offsite use

6. What type of event are you requesting?

• Procedures
• Simulation (e.g., simulated patient scenario, mock code)
• Point of Care Ultrasound (POCUS)
• Bioskills/Cadaver
• Not Applicable

7. Requested location of event? 

• 109 Michigan Doug Meijer Medical Innovation Building (MIB)
• 275 Michigan Corewell Health Clinical Simulation Center (CSC)
• In situ (your space/location)
• Not Applicable