OR Central Medical Emergency Clipboard Questions Name of sick or injured person UW workplace of person Date and time Recorder’s name left right What parts of your body are affected? indicate on the figure, add any notes When did the symptoms How did the problem occur? Location where problem occurred? What have you done so far to treat this? Is there anything else you’d like us to know? Emergency contact name and phone # Any other information Check off any actions taken ____ CPR chest compressions ____ Called 911 ____ CPR assisted breathing ____ ORC management informed / name: _________________ ____ Defibrillation ____ Other: ____ Compression for bleeding
OR Central Medical Emergency Clipboard Questions Name of sick or injured person UW workplace of person Date and time Recorder’s name What parts of your body are affected? indicate on the figure, add any notes left right When did the symptoms How did the problem occur? Location where problem occurred? What have you done so far to treat this? Is there anything else you’d like us to know? Emergency contact name and phone # Any other information Check off any actions taken ____ CPR chest compressions ____ Called 911 ____ CPR assisted breathing ____ ORC management informed / name: _________________ ____ Defibrillation ____ Other: ____ Compression for bleeding
Intranet-Husky-Ready-6-21-12-Clipboard-questions.docx