Please fill out the following form for each simulation session requested to be held at the Intermountain Simulation Center. Provide as much information as possible so that we can efficiently manage resources and be prepared to help make the simulation a success.

A meeting with a simulation coordinator and simulation technologist is required to help with the planning of your simulation. We will approve/deny the request and get back with you within seven business days. Completed scenarios are due no later than 2 weeks prior to the actual simulation date.

This form should not be used for urgent care matters or potentially life threatening conditions. In those situations, please contact 911 or head to the nearest Instacare or emergency room.

General Information
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Is the requester also the content expert for the simulation?
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Resources
Simulators you plan to use
Will you provide your own standardized patients?
Individual Session Information
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Would you like help writing the scenarios? (NOTE: Simulations need to be tested before being used.)
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Equipment Needed
Carts
Kits
Suturing Supplies
Patient Care Equipment
Specialized Task Trainers
AV Equipment Needed
Live stream feed to debriefing/conference room
4-camera view including patient monitor
Walkie-talkies with microphones
General