Professional Documents
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2020 Kuitpo Forest Day Walk Info Pack
2020 Kuitpo Forest Day Walk Info Pack
Walk is a loop from Forestry HQ – south along Heysen to Prospect Hill trail head - (if
time permits then a return walk from Prospect hill trail head to Kyeema) – Christmas
Hills Forest (via forest between Heysen Trail and Brookman Road) – Forestry HQ
What to Bring
• Daypack
• Lunch and snacks for up to 8 hours
• 2L of water
• Raincoat
• Rain pants (weather dependant)
• Sun hat and warm hat
• Warm clothes such as a fleece jumper to wear when not active
• Sunscreen
• sunglasses
• Pen and paper
• Whistle
• Personal medication such as asthma puffer etc…
• Personal first aid kit
• Phone with phone numbers entered
• Smile
• Camera (optional)
• Toileting kit
What to Wear
• Comfortable walking shoes
• Thick walking socks
• Comfortable walking clothes that can be added to (must also be sun smart)
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Leaders will bring
• Maps and compasses
• First aid kit
• Phone
• Your medical details
• Emergency shelter
000
Assessment
As a part of this experience you are required to write a 1 page reflection to include in your
Outdoor Education Portfolio. You may choose to collate photos and videos to support this. See
assessment item 3 for details
Additional
• You may wish to access the BLSA website prior to this experience and begin a
bushwalking logbook.
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Brief Plan
Important.
1. All directions provided refer to the general direction of travel rather than the specific direction
of travel at the time of leaving track junctions.
2. Always stay together in your group.
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Route Travelled Emergency Escape Route
Begin at Forestry HQ travelling south along Heysen trail to Prospect West to Brookman Road
Hill MTB trail head.
If time Permits continue south on Heysen trail to Kyeema South to Kyeema car
Conservation Park park
Return north along Heysen trail to Prospect Hill MTB trail head. North to Brookman
Connor Road
Return south along Christmas hill road to Tinjella trail West to Brookman Road
East along Tinjella trail through Christmas hill forest to join Heysen West to Brookman Road
Trail
South on Heysen trail to Forestry HQ West to Brookman Road
Maps
Start
Brookman
Road
Heysen Trail
Christmas
Hill Road
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Risk Assessment and Management
Kuitpo Forest
Table of Contents
Risk Assessment and Management ............................................................................................................................. 7
Context Establishment ............................................................................................................................................ 8
Risk Identification ................................................................................................................................................... 9
Risk Analysis and Management Strategy ............................................................................................................... 10
Dynamic Risk Assessment Framework ................................................................................................................... 21
Emergency Management Planning Details............................................................................................................. 22
Planning ............................................................................................................................................................ 22
Preparation ....................................................................................................................................................... 22
Response .......................................................................................................................................................... 22
Recovery ........................................................................................................................................................... 23
Incident and Emergency Response Plans ............................................................................................................... 23
Accident Report Form ........................................................................................................................................... 24
Emergency – Serious Incident Form ...................................................................................................................... 25
7
Context Establishment
Activity
Type Single day bushwalk and orienteering
Purpose of activity Build an understanding of walking longer distances and requirements
associated such as
• Plan and prep
• Equipment including clothing, food, water, etc…
• Technical capabilities including navigation and timing
• Essential capabilities such as leadership styles and debriefing
Date and time 8.45am – 4pm
Wednesday 15th July
Friday 17th July
Participant
Participants (number and group) 30 participants plus 2 Instructors as 2 separate groups (1:22 for day walks
with adults - AAAS)
Climate and weather Conditions will be varied during these days and therefore weather
information will be included in information packages and participants are
required to also gather this information as part of their leadership
preparation. Generally these areas experience mild to cold conditions and
some rain is likely during this time of year. Instructors must make sound
judgements relating to weather and hail or lightning must force a
cancellation of activity. As this area is governed by forestry fire warnings
and logging closures will also be considered and may result in location
change or cancellation.
Sustainability • Apply leave no trace principles in all locations
• National parks guidelines for conservation parks applied even though
officially forestry are (Kyeema is recognised conservation park)
• Apply considerations for Phytophthora – cleaning principles on shoes
and equipment that contacts soil.
• Use identified paths only
Land owner / manager requirements • Not to proceed on catastrophic fire danger – check parks advice on
extreme fire danger.
• No permits as this is part of an educational experience rather than as a
tour operator.
Leadership • Abide by ratio recommendations (AAAS) of 1:22
• Minimum day walk leader required as tracks are class 1-2
Roles and responsibilities • Leaders of each group to enact duty of care and align with roles
outlined in leader prep package.
• Leaders are to make sound and informed judgement within their
qualification or equivalent recognition of experience.
• Students and Leaders to complete FlinSafe agreement and abide by
this.
Competencies required • Day walk leader or equivalent
8
Supervision • Abide by ratio recommendations (AAAS) of 1:22
• While orienteering outer boundaries are set, must always work in pairs
with a phone
• If lost, head west to Brookman Road
Logistics and equipment
Equipment Outlined in information pack
Logistics Outlined in information pack
Communications Outlined in information pack
• Phones (leaders and students)
Risk Identification
Risks (list of possible events where an accident, injury or loss could occur)
1. Motor vehicle accident 2. Exposure to elements 3. Heat stress / dehydration
including development of
hypothermia or
hyperthermia
4. Inadequate nutrition or 5. infection, gastro, etc… 6. Medical emergency
hydration
7. Physical Injuries 8. Manual handling 9. Bites and stings
10. Sun burn 11. Natural disaster 12. Split group or lost participant
13. Anxiety 14. Exposure to a virus 15.
Now transfer to below and identify for each risk, the risk factors under categories of:
Then complete
• Assessment of risk
• Identification of management strategies
• Implementation of risk management
9
Risk Analysis and Management Strategy
Risk Calculation Matrix
Consequence
Insignificant (I) Minor (mi) Moderate (Mo) Major (MA) Catastrophic (C)
Almost Certain (A) High (H) High (H) Extreme (E) Extreme (E) Extreme (E)
Probability Likely (L) Medium (M) High (H) High (H) Extreme (E) Extreme (E)
Possible (P) Low (L) Medium (M) High (H) High (H) Extreme (E)
Unlikely (U) Low (L) Low (L) Medium (M) High (H) High (H)
Rare (R) Low (L) Low (L) Medium (M) Medium (M) High (H)
Kuitpo Forest
10
Obtain From Risk Factor Risk Analysis Risk Management
Identification
Risk RF P C Ris Comments on Risk Management Strategy Resources Required Residual Communication
k Risk Required
Lev
el
1 - Motor 1 - fatigue U C H Driving is not within • Appropriate licences • Participant R MA Leaders to
vehicle the timeframe of the • Locations within 1.5 hour of information M discuss vehicle
accident (P) field trip as Adelaide package logistics prior
participants will • Finish time is prior to dark including maps to departure
1 – reckless U C H meet at and leave • Appropriate licences R MA
driving from the identified • Provide location information prior M
location, however • Must obey road rules
1 - Motor 1 – hazards on U MA H they will be informed • Appropriate licences R MA
vehicle the road of the risks • Must obey road rules M
accident (En) associated, and be
provided with
1 - Motor 1 – unclear R I L • Appropriate licences RI
location information.
vehicle route • Clarify routes between leaders L
accident (EL) before departure
• Info packs
2 - Exposure 2 – incorrect P Mo H Students undertake • Participant info books • First aid kits R Mi Info in prep
to elements information to preparation • Participants required to access including L workshop
including participants workshops and are weather emergency
development including required to access • Equipment checked prior to blankets
of weather details weather information departure • Equipment lists
hypothermia themselves. to leaders and
or Weather info is also participants
hyperthermia provided in
(P) information
2– U Mo M packages. A packing • Maintain ratios R Mo
inappropriate list will assist with • Constant supervision of group while M
supervision preparation – walking
leaders should check • Lost procedures identified for
that appropriate orienteering
11
clothing is worn and • Appropriate management strategies
equipment has been such as markers
packed prior to • If lost stay by the track or head west
commencing to brookman road and send a text
message to leader and group
members
2 - Exposure 2 – weather P Mo H • Participant handbooks R Mi
to elements conditions and • Inform of weather access in prep L
including changing days prior to walk
development weather • Check equipment pre departure
of • Thermal blanket in first aid kit
hypothermia • Exits identified and easily accessible
or
hyperthermia
(En)
2 - Exposure 2 – broken, P Mo H • Equipment check prior to departure R Mi
to elements missing or • Exits identified and easily accessible L
including inappropriate
development equipment or
of clothing
hypothermia
or
hyperthermia
(EL)
3 - Heat stress 3 – incorrect U Mo M We are in metro • Info packs to students advising 2L • Equipment list in R Mi
/ dehydration information locations and can minimum information L Info in prep
(P) from leader exit activity easily if package with workshop
3 – insufficient U Mo M needed • Info packs to students advising 2L advice on water R Mi
water or minimum L
equipment • Monitor intake throughout the day
packed
3 - Heat stress 3 – high U Mo M • Check weather prior to departure U Mi
/ dehydration temperature • Appropriate clothing including hats L
(En) • Exit if needed
3 – lack of L Mo H • Info packs to students advising 2L of U Mi
shade water minimum L
12
• Monitor drinking
• Appropriate clothing to be packed
including hat
• Seek shade where available – exit if
needed
3 - Heat stress 3 – insufficient U Mi M • Info packs to students advising 2L of R Mi
/ dehydration access to water water / day minimum L
(EL) • Monitor intake throughout the day
4- 4 – incorrect R Mi L Prior workshop with • Easy exit is possible • Suggested food RI Info in prep
Inadequate information info provided and water in L workshop
nutrition or from leader information
hydration (P) We are in metro package Procedures for
4 – illness U Mi L locations and can • Students able to notify leader R Mi missing
exit activity easily if • No attendance if unwell L sessions due to
needed • Easy exit is possible illness
4 – lack of R Mi L • eating as a group to make RI
observation monitoring easier for leader L
from leader • pre check food before departure
4- 4– R Mi L • Check weather prior to departure – RI
Inadequate temperature adjusted schedule above 30 degree L
nutrition or requiring celcius
hydration (En) increased • Info packs to students advising 2L of
intake water / day minimum
• Easy exit is possible
4- 4 - insufficient R Mi L • Info packs to students advising 2L of RI
Inadequate access to water water / day minimum L
nutrition or • Easy exit is possible
hydration (EL)
5 - infection, 5 – poor R Mi L As these are single • Sanitiser in first aid kit • Hand sanitiser in R Mi Discuss with
gastro, etc… hygiene day trips it is unlikely • Info provided on toileting bag L students in pre
(P) practices that these will • Hand washing or sanitising prior to departure ws
develop. Students eating
5 - infection, 5 – contact U Mi L may not attend if ill • Encourage safe food practises R Mi
gastro, etc… with dirty and make alternate including bringing hand sanitiser L
(En) surfaces, etc… arrangements
13
5 - infection, 5 – off food or U Mi L • Prior departure information to R Mi
gastro, etc… uncooked indicate safe practices with meat. L
(EL) meats • Meets needing refrigeration not to
be brought
6 - Medical 6 – specific P MA H Medical information • Medical summaries to leader • First aid kit R MA Discuss with
emergency medical collected prior, • Check specific or unknown details complying with M students in pre
(pre-existing) conditions personal medication with participants AAAS guidelines departure ws
(P) to be checked and • Personal medication to be carried • Personal first aid
discussed with • 1st aid kits to follow AAAS standards and medication Communication
leader prior to • Easy exit is possible • Medical forms of flinsafe
6 – food P MA H departure. • Medical summaries to leader R MA
packed that • Check specific or unknown details M Communication
could initiate with participants with all leaders
allergic • Personal medication to be carried
reaction • 1st aid kits to follow AAAS standards
• Easy exit is possible
• Allergy information shared with
group where necessary eg. Food
allergies not to bring
6 – low level of P Mi M • Group to check route plan R Mi
fitness • Injuries to be cleared with medical L
practitioner prior to departure
• Group to move as fast as slowest
participant
• Plans easily adjusted to return to
cars sooner or pick students up
from Brookman Road
6 - Medical 6 - allergens P MA H • Medical summaries to leader R MA
emergency present • Check specific or unknown details M
(pre-existing) with participants
(En) • Personal medication to be carried
• 1st aid kits to follow AAAS standards
• Easy exit is possible
• Allergy information shared with
group
14
6 - Medical 6 – route not U Mi L • Changes can be made easily R Mi
emergency appropriate for L
(pre-existing) fitness level
(EL)
6 – incorrect or U C H • Medication checked pre departure R MA
missing • Medical summaries to leader M
medication or • Check specific or unknown details
preventative with participants
strategies • Personal medication to be carried
• 1st aid kits to follow AAAS standards
• Easy exit is possible
• Allergy information shared with
group
7 – physical incorrect P MA H Instructors are to be • Operate within appropriate ratios • First aid kit R Mo Info packages
injuries (P) application of suitably qualified and scope of qualification complying with M for info
self- and apply sound • Prior briefings AAAS guidelines
management judgement • Medical forms
Tripping in pine U MA H associated with • Operate within appropriate ratios • Phones for R Mo
forest qualification and scope of qualification communication M
• Remain on defined trails • Info packages
• Off track sections defined by
instructors
participant not U MA H • Expectations established R Mo
following • Flinsafe signed M
instruction or • Pre departure info
ignoring • Operate within appropriate ratios
forestry and scope of qualification
working signs • Ongoing monitoring
incorrect use P MA H • Operate within appropriate ratios R Mo
of equipment and scope of qualification M
• Prior briefings to inform correct
technique such as pack lifting and
monitor
• Establish working areas and
management techniques
15
7 – physical Unstable, P MA H • Appropriate walking shoes R Mo
injuries (En) uneven or • Instructor to monitor suitability of M
loose ground track
slippery ground P MA H • At water crossings establish most R Mo
such as after stable route M
rain
7 – physical equipment U MA H • Check packs and footwear prior to R MA
injuries (EL) failure departure for suitability M
Incorrect U MA H R MA
footwear M
Route crossing U MA H • Observe information and reroute •
roads of signs
through
forestry
activity
8 - Manual lack of leaders U Mi L Adjustments for • Correct technique shown to bags • First aid kit R Mi
handling (P) instruction or existing injuries and monitored complying with L
observation • Share carrying load AAAS guidelines
participant U Mi L Share carrying • Medical forms R Mi
misbehaviour responsibilities L
including not
listening
incorrect lifting P Mo H R Mi
or carrying L
8 - Manual
handling (En)
8 - Manual weight of bags P Mo H U Mo
handling (EL) M
9 - Bites and participants U Mo M First aid kit to follow • Stay in ratios • First aid kit R Mo • Discuss to
stings (P) not following AAAS suggestions • Clear leader instruction regarding complying with M stay on
leaders and be checked prior management techniques and AAAS guidelines tracks and
instructions to departure operating boundaries • Medical forms in open
• Stay on tracks where possible and in • Info packs areas
operating boundaries
walking off P Mo H • Leader to monitor R Mo
track M
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9 - Bites and insect or spider P Mi M • Instruction on how to monitor U Mi
stings (En) bites and spiders L
strings • Don’t lift rocks / bark / logs etc…
• Stay in designated areas
snake bites U MA H • Do not approach R MA
• Stay still if sited M
• Remain on paths when available
• Stay as a group and in designated
areas
• Don’t lift rocks / bark / logs etc…
9 - Bites and incorrect U Mo M • Equipment check pre departure R Mo
stings (EL) footwear or • Info packs provided M
clothing
10 – Sun burn not applying P Mo H First aid kit to follow • Slip, slop, slap, seek, slide • First aid kit R Mi Information in
(P) correct AAAS suggestions considered in equipment list and complying with L pre departure
clothing or sun and be checked prior monitored. No participation if non- AAAS guidelines workshops
protection to departure. compliant • Medical forms
10 – Sun burn over exposure P Mo H • Seek shade where possible • Info packs R Mi
(En) to the sun Weather information • Weather info L
10 – Sun burn incorrect P Mo H to be obtained prior R Mi
(EL) clothing or sun L
protection Info packs provided
extended time P Mo H to advise R Mi
in the sun L
11 - Natural Students not R MA M Rules and • Pre departure information • First aid kit R Mi Weather
disaster (P) following expectations are set regarding expectations and complying with L updates
leader in pre departure consequences AAAS guidelines discussed on
instruction workshops. Students • Weather checks by all • Medical forms day of
Lack of R MA M encouraged to ask • Pre departure info regarding • Info packs R Mi departure
information clarifying questions weather and natural disasters info L
from leader
11 - Natural Bushfire R C H Weather information • Check weather information pre R MA
disaster (En) to always be gained departure M
and national parks • Change plan on closure days
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Thunderstorm R C H guidelines regarding • Check weather information pre R MA
closures followed departure M
• Do not proceed during thunder
• Exits are easily accessed
Gale force R C H • Areas mostly protected R MA
winds • Exits are easily accessed M
• Weather checks pre departure
Falling trees or R C H • Check the area for dead trees and R MA
branches limbs to avoid M
• Remain on track in naturally
vegetated areas
11 - Natural incorrect or R MA M • Weather information to be checked R Mo
disaster (EL) absent pre departure M
weather
information
12 - Split lack of R Mo M Maintain ratios • Maintain ratios • Information R Mi
group or lost appropriate Common leadership • Common leadership techniques to packages L
participant(P) supervision techniques to be be applied.
participant R Mo M applied. • Group briefed to remain where you R Mi
misbehaviour are if split group on track or if off L
inadequate R Mo M Clearly identify track head west to Brookman road R Mi
leadership working areas and text leader L
techniques • Never venture alone
12 - Split unclear trail R Mo M • Maps in info packs R Mi
group or lost • Rules and expectations set and L
participant agreed on pre departure
(En)
12 - Split incorrect R Mo M R Mi
group or lost participant L
participant ratios
(EL)
13 – Anxiety inexperience P Mi M Monitor for signs • Pre departure workshops informing • Medical forms U Mi Development
(P) and prepare students L throughout the
students for • Information package supplied sessions will
• Monitor for debrief enable
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uncomfortable P Mi M expectations in pre • Pre departure workshops informing • Info packs U Mi students to
toileting or departure workshop. students carried with exit L also analyse
hygiene • Information package supplied points identified situations and
practices As these are day • Monitor for debrief • Trowel and toilet build
period P Mi M trips, adjustments • Take trowel and toilet paper paper U Mi knowledge that
can be made and L helps them
history P Mi M exits accessed easily • Pre departure workshops informing U Mi understand the
students L options
• Information package supplied available to
• Monitor for debrief them.
• Can be declared in medical
information
unknown P Mi M • Pre departure workshops informing U Mi
students L
• Information package supplied
• Monitor for debrief
13 – Anxiety extreme P Mi M • Pre departure workshops informing U Mi
(En) weather students L
• Information package supplied
• Check weather pre departure
• Monitor for debrief
13 – Anxiety Length of walk P Mi M • Pre departure workshops informing U Mi
(EL) students L
• Information package supplied
• Monitor for debrief
• Building knowledge throughout
• Identify exit strategies
14 – exposure hygiene P Mo H The federal and state • Students advised to shower before https://www.health. U Mo • New
to a virus (P) practices governments and after activity (at home gov.au/sites/default/ M manageme
provide clear preferable) files/documents/202 nt
guidelines for • Hand sanitiser must be brought 0/05/australian- guidelines
preventing the • Coughing/sneezing etc to be institute-of-sport- provided to
spread of corona directed away from others, into ais-framework-for- students
virus. elbow and sanitising to be applied rebooting-sport-in-a-
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not applying P Mo H • Checks to be done visually from covid-19- U Mo • Communic
social COVID safe plan to 1.5m environment.pdf M ation about
distancing be provided and • Physical distancing applied at all current
followed times where safety is not covid safe
compromised COVID procedures practices
pre existing P Mo H • Students enforced to stay home if checklist to be U Mo
infection experiencing symptoms such as followed M
fever, sore throat, common cold,
etc…
high risk P Mo H • To be communicated with leader U Mo
category and in medical information and M
medical professional advice to be
followed
14 – exposure • Physical distancing to be applied on U Mo
to virus (En) tracks and at all rests M
14 – exposure vehicles A Mo E • Self drive, limited car pooling and U Mo
to virus (EL) social distancing to apply M
multiple A Mo E • the likelihood of community U Mo
people needed transmission is incredibly low. M
for activity Equipment will be minimised,
however hygiene practices outlined
above will be applied.
Date Reviewed: 25/6/2020 Reviewed By: Joss
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Dynamic Risk Assessment Framework
Was significant dynamic risk assessment conducted during this activity last year resulting in change?
No changes required
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Emergency Management Planning Details
Planning
• emergency response actions, allocated roles and responsibilities
o roles outlined in information pack and respones outlined below in incident and emergency plans
• closest available professional medical care (e.g. hospital, clinic, doctor)
o outlined in information pack
• contingency plans for foreseeable emergencies (e.g. injuries, fire, flood)
o walk west to Brookman Road, text leaders and wait for pick up
o multiple access points indicated in maps and route if evacuation needed
o dealing with injuries outlined below in incident and emergency response plans
• strategies relevant to the features of the area being visited
o outlined in risk identification
Preparation
• emergency access and escape routes (where possible)
o see route outlined in info pack
• assembly points where appropriate
o brookman road between HQ and Kyeema
• details of key organisations (e.g. ambulance, land manager, local police) and how to best contact them in an
emergency
o outlined in information pack
• communication equipment that will be used, including coverage notes and/or limitations (e.g. mobile phone,
satellite phone, radio)
o outlined in leaders information pack
▪ mobiles sufficient for locations
• relevant aspects of the land manager’s emergency strategy (e.g. gaining assess past locked gates)
o outlined in information pack
o no permits required for educational groups
Response
• the process or procedures for responding to an emergency
o outlined below in incident and emergency response plans
• the process or procedures to confirm or ensure the safety of a group that fails to return or check-in as planned
o outlined in flinsafe approvals
• the emergency trigger for a non-participating contact, to commence the planned process or procedures to
confirm the safety of the group and/or inform emergency services if the group fails to return or check-in
o outlined in flinsafe approvals
o leaders to identify Joss of completion by 4.30pm
o if no contact by 4.30pm, Joss to contact leaders
o if no contact by 5pm emergency services will be notified
o Joss notified as soon as possible of incident or emergency
• a strategy for maintaining appropriate participant supervision if the planned activity changes (e.g. an injured
leader is evacuated or escorting participants who are withdrawing from the activity)
o consult info pack and exit strategies
o ratios must be maintained
o follow check in procedures
o phone procedures outlines emergency response
• access to personal contact and medical information
o to be carried in hard copy by leaders
22
o stored in flinsafe
Recovery
• reporting requirements for fatalities, serious injuries or illness and dangerous incidents
o outlined below in incident and emergency response plans
Emergency
❑ Have students call emergency services from mobile 000 or 112 (follow incident report form included)
❑ Manage group (instructor 1 to identify safe location and allocate leader to monitor).
❑ apply first aid (leader in charge to administer or delegate to willing trained first aider)
❑ Debrief group to what is happening. Group members positioned to help identify casualty site for emergency
services.
❑ Prepare group and victim for evacuation via either air lift or identified exit location on the route outline
❑ Preserve site if major emergency or fatality where practical
❑ Evacuate group.
❑ Contact university contact and emergency contact as soon as practical
❑ Once practical incident report must be entered to Flinsafe and national UPLOADS project
❑ The effective management of any incident in the field will, for the most part rely on sound judgement and
decision making from the group leaders on the scene.
❑ University to be consulted regarding student and staff support and counselling that is available.
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Accident Report Form
Nature of Injury
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_____________ ____________________________________________________________
Description of Accident
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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Emergency – Serious Incident Form
(YOU MUST FILL IN THIS FORM FOR AN ACCIDENT THAT HAS CAUSED INJURY OR WHERE CONDITIONS REQUIRE
MEDICATION OR ONGOING TREATMENT)
We have a casualty who is a ……………………..year old male/female whose Chief Compliant is:
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………......(symptom)
The patient states/witnesses state: (Mechanism of injury/History of present illness)
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
Observations patient found (describe position). Patient exam reveals (observation / injury). Vital Signs at (time).
Patient Exam
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
Vital Signs
NORMAL 1 2 3 4 5 6
TIME
General
details
HR 50-100bpm
RR 12-20
(breaths/min)
SCTM PINK/WARM/DRY
TEMP 37 deg
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HISTORY
Symptoms…………………………………………………………………………………………………………………………………………………………………….
Allergies……………………………………………………………………………………………………………………………………………………………………….
Medications………………………………………………………………………………………………………..……………………………………………………….
Pertinent medical history…………………………………………………………………………………………………………………………………………….
Last intake/output………………………………………………………………………………………………………………………………………………………
Events…………………………………………………………………………………………………………………………………………………………………………
ANTICIPATED PROBLEMS…………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………..
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