Simulation Booking Request Form

Required fields are marked with asterisks (*)

Lead Sim Username *

Department *

Phone Number*

I confirm I am Toronto Metropolitan University faculty:*

Yes

TMU Email Address:*

Participants currently onsite for clinical placement or shift? *

Yes No

Select site of simulation activity: *

Brampton Civic Etobicoke General Peel Memorial Other

Indicate your level of simulation operation support that you require for your session: *

No simulation technician or education support needed
Simulation technician support and/or education support needed

Terms and conditions:

To book a simulation session or equipment please complete the booking request form at least two weeks prior to the requested date. Bookings made after this time will be subject to availability. Once the booking request form is submitted, please allow at least three business days to receive a response from the simulation team.
If scheduling conflicts cannot be resolved despite efforts to offer flexibility with dates, times, resources and/or locations, a priority matrix will be employed to guide resource allocation and decision-making. The Simulation Lab operates Monday to Friday. For any cancellations, please email PP.SimBooking@williamoslerhs.ca with at least 24 hours' notice.
All facilitators and instructors are expected to have training in simulation best practice pedagogy and have had a recent orientation to the Osler simulation spaces and equipment. Facilitators and instructors are responsible for contacting the Simulation Lab to arrange a time for orientation.
Task trainers and manikins must not be left with liquid inside. Please discard into the labelled 'simulation waste bucket' found in the room. At the end of your session, ensure you have emptied the 'simulation waste bucket' contents down the nearest toilet or approved sink.
All simulation manikins and equipment should be cleaned using labelled manikin approved wipes. Do not use any other disinfectant agent. Rooms must be left in the condition and configuration in which they were found.
The simulation space and equipment are not to be used for any patient care or to manage an emergency code.
Simulation equipment may only be removed from the room by prior arrangement and booking. Equipment must be returned at the date and time previously agreed upon with the simulation operations team. Equipment will be signed out and back in after each use in collaboration with a simulation operations member.
Food or drink are not permitted in the simulation spaces. Food or drink is only allowed in the debrief rooms when simulation equipment is not present. Please take food remains with you and do not dispose of it in the simulation spaces.
Damages to equipment are the responsibility of the user and may result in departmental fees. Should equipment damage or malfunction occur, inside or outside of the Simulation Lab, please complete the Simulation Program damage report form.
Participants are required to submit the simulation confidentiality agreement annually. The session facilitator is responsible for ensuring participants have completed the Simulation Program confidentiality and participation agreement.
For simulation sessions that are recorded or photographed, participants will need to review and consent to the simulation audio/visual recording and photography agreement provided by the facilitator prior to the simulation session.
Post-session satisfaction evaluation survey must be completed at the end of each session by participants for program quality improvement purposes. All responses are anonymous. Please ensure all participants scan the QR code posted in each simulation space.

I have read and understand the terms and conditions listed above: *

Yes

The Lead Sim User reserving the space is responsible for the session and ensuring terms and conditions are met.  Food and drink will not be permitted in rooms with simulation equipment. For the safety of everyone, invasive procedures will not be performed on humans within any of the simulation spaces.

I have read and understand the terms and conditions listed above: *

Yes

Session information

Title of session *

Type of simulation activity (select all that apply): *

Hospital orientation using a simulation modality

Skills/procedural based training

Scenario-based (high-medium fidelity)

Performance improvement plan review using a simulation modality

Workshop/conference

Other

Please state the purpose of your session (select all that apply): *

Learning

Assessment

Research

Translational/systems integration

Session learning outcomes (what you hope your learners will achieve at the end of the session) *

Participant arrival time (note: a minimum of 30 minutes will be allocated for setup and take down based on session start/end time) *

Participant departure time (note: a minimum of 30 minutes will be allocated for setup and take down based on session start/end time) *

Alternative date(s) and session start/end times if initial request not available: *

Is this a recurring session? *

Yes No

Evaluation of effectiveness of session? *

Kirkaptrick Model Other

Participant information

Total number of anticipated participants: *

Is your session interprofessional? *

Yes No

Are students participating in the session? *

Yes No

Equipment information

Are you looking to book a mobile simulation cart (Code Blue)? *

Yes No

Simulation support and terms and conditions

To better support you in your simulation experience, please review and complete the following. Select the response that most applies to the lead instructor who will be facilitating the session.

How confident are you in using simulation technologies (i.e., mannikin, task trainers, software): *

Very confident Fairly confident Moderately confident Not confident

How confident are you in using simulation best practices to facilitate a simulation session: *

Very confident Fairly confident Moderately confident Not confident

How confident are you in using a standardized simulation debriefing framework: *

Very confident Fairly confident Moderately confident Not confident

It is encouraged that in advance of your simulation session you complete the Learning Management System simulation modules and book an orientation to the simulation spaces, equipment and AV with the Simulation program lead by emailing PP.SimBooking@williamoslerhs.ca.

Osler Forms