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đ¨ Security Incident Form
âŠī¸ Old Medical Form
Scream Town â First Aid Incident Report Form
Incident Information
Date of Incident
Time of Incident
Location (Attraction/Area)
Person Involved
Full Legal Name
Date of Birth
Age
Over 18
Under 18
Phone Number
Address
Parent/Guardian Information (if under 18)
Full Legal Name of Parent/Guardian
Phone Number
Relationship to Minor
Nature of Incident
Injury (cut, scrape, fall, etc.)
Breathing difficulty
Dehydration
Suspected drug/alcohol use
Other
Incident Description (Completed by Staff)
(Please describe in detail what occurred, including actions taken, witnesses, and any contributing factors.)
Care Provided (Completed by Medic/Security)
First Aid (Bandage, ice, etc.)
Monitored Vital Signs
EMS Called / Transported
Other
Staff Reporting
Name of Staff (Print)
Position (Medic / Security / Other)
Staff Signature (required)
Clear Staff Signature
Date
Acknowledgment by Person Involved
I acknowledge that this report is a true account of the incident as I understand it.
Signature of Person Involved (or Guardian)
Clear Person Signature
Date
Individual declined to sign acknowledgment (staff initial this box)
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