Medical Incident Report
This report is used to document any medical emergency that requires medical intervention. It should be completed and submitted by the close of business on the day of the incident.
Camper's Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Specific Location of Incident
Complete details of the accident and extent of injury (if known)
Was first aid given?
No
Yes
If first aid was given, by whom?
Director
Asst. Director
Team Lead
Other
Was camper taken to hospital?
No
Yes
If camper was transported, how were they taken?
Ambulance
Agency Security
Camp Staff Vehicle
Parent/Guardian
Other
Camp Staff on Duty at the Time of the Accident
Person Making Report
Date
-
Month
-
Day
Year
Date
Camp Director
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: