First Aid Form

First Aid Form (WCS)

Injury/Illness
Person Information

Impacted by injury or illness
Report In
Incident Type
RISK DESCRIPTOR
Urgent Serious Risk - Immediate Action
Someone was hurt, or there is still a very high chance of someone getting badly hurt as the situation hasn’t been resolved. First Aid/Police/Ambulance/ Hospital required.
Level of Alert
Name of Participant

First NameLast Name
Date of Injury/Illness

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Time

:HourMinutesAM/PM Option
Where the situation occurred - location
Current Medications (as per Monday.com)
Allergies (if known)
First Aider

First NameLast Name
Email of First Aider
example@example.com
Position
Site
What happened?
What happened leading up to the injury/illness?
Who first identified the problem/what did they observe?
What happened?

Complete observations

Rows	Obs 1	Time of Obs 1	Obs 2	Time of Obs 2	Obs 3	Tine of Obs 3
Pulse Rate per min Regular/Irregular
Breathing Rate, Depth, Noises
Conscious State Responds to: voice/touch/pain
Skin Colour normal/pale/flushed
Skin Temperature hot/warm/cold
Skin Moisture dry/moist

Other Observations
Please note where on the body the above issues impact.
What was done

First aid treatment
What first aid/assistance was provided
Which First Aid Kit did you use?

Other
Name Car or House where kit was located
Please identify what has been used out of the first aid kit
Who did you contact

Other
Time of Contact for outside support (if required)

:HourMinutesAM/PM Option
Time they arrived (if required)

:HourMinutesAM/PM Option
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Upload Photos

Browse Files

Cancelof
Signature of First Aider
Office/Management Section
Site
Date of Birth of Participant

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Address of Participant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Parent/ Guardian/Next of Kin

Area CodePhone Number
Email of Parent/Guardian/Next of Kin
example@example.com
Contacted
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Name

First NameLast Name
Office Signature
Version date 16.05.2022
Should be Empty:

First Aid Form (WCS)