Camp Medical Incident Report

Major Medical Incident Report

Please use this form in cases where more than basic First Aid was required to resolve health complaint or injury. This can include concussions, allergic reactions, hospital trips, etc. These details can be used for future reference, follow up with parents/guardians, and/or communication with insurance companies. Thank you for being thorough.

Date / Time of Incident *

Date

Time

Participant's Name *

First

Last

Event *

2021 Kids Camp @ Gwinwood, July 12-15
2021 Kids Camp @ Cane Ridge West, July 12-15
2021 Junior Camp @ Gwinwood, July 12-15
2021 Junior Camp @ Cane Ridge West, July 12-15
2021 Chi Rho Camp @ Gwinwood, July 19-24
2021 Chi Rho Camp @ Cane Ridge West, July 19-24
2021 CYF Camp @ Gwinwood, July 19-24
2021 CYF Camp @ Cane Ridge West, July 19-24

Was the Parent/Guardian/First Emergency Contact able to be reached and included in treatment decisions? *

Yes
No
Second Emergency Contact was used.

Incident Details *

Example: Camper fell while playing soccer in the upper field at free time. Camper friends X, Y, and Z carried injured camper back to the lodge for examination.

Treatment *

Example: Attempted First Aid of ice and elevation and administered OTC Advil. Swelling and pain continued. Emergency Contact agreed Urgent Care visit was warranted and camper was transported by Adults X and Y. Examination and X-ray show no fracture, bad sprain. Parent/Guardian and camper elect to continue attending event with proper medical support (ice, pain relievers, support bandage) and modified activities.

Medical Reports

Click or drag a file to this area to upload.

If available, please scan any paperwork or reports received at the time of Urgent Care/Hospital treatment.

Other Notes

Please use this area to add any other commentary you think is helpful for the records.

Your Name and your Role at this event: *