1. Introduction
This manual provides basic instructions for actions to be taken in case of emergency at Century High School. One copy should be provided to each staff member. Near the beginning of every semester the Principal should inform all staff members about the manual and review its contents briefly with them. Each staff member should keep a copy visible and within easy reach.
2. Severe Weather Conditions
In case of severe weather conditions (snowstorm, heavy snowfall, windstorms which cause serious damage) Century High School will follow the action taken by the Vancouver School Board. Staff members should stay tuned to major radio stations to find out whether the school will be closed or not.
3. Management of Medical Incidences
3.1 Minor Medical Incidences Occurring In-School
a) Any staff member may supply students with bandaids for minor cuts or scrapes. Ask student to wash the wound gently with warm water and soap before applying the bandaid. However, if the cut or scrape is very dirty, it will need to be cleaned with gauze and peroxide and then rinsed and dried before covering it. (The First Aid Attendant may be called if necessary).
b) Any staff member may also supply students with an ice pack for minor swelling from minor bumps, chafing, sprains or burns (however, submerging the burn in cold water is more effective).
3.2 Management of Nosebleeds (Epistaxis)
Nosebleeds are common emergencies and, on occasion, can cause shock and even death. There may be only a small amount of blood visible, as it often goes down the throat and is swallowed. If blood is swallowed, vomiting may ensue.Most nosebleeds can be treated at the accident scene of first aid room. Treat at the scene if there’s significant blood loss; walking makes it worse.
- Apply constant pressure by pinching the nostrils for 15-20 minutes. Apply cold packs to the bridge of the nose and the forehead.
- Keep the patient sitting, if possible, with the head forward. The traditional practice of tilting the patient’s head back is not recommended because blood may trickle down the throat. The person may swallow blood or possibly choke on it. The patient should be encouraged to cough or spit out any blood but should not blow the nose.
- Keep the patient quiet. If the patient suffers from high blood pressure or is anxious, the agitation may increase blood pressure and the bleeding.
- A person with a prolonged nosebleed (greater than 30 minutes) should be taken to medical aid. Nasopharyngeal packing should be done only by a physician
3.3 More Serious Medical Incidencesa) In case of more serious medical incidents have the receptionist page the designated First Aid Attendant. The designated First Aid Attendant is Ms. Helen Escauriaga, who holds a CPR-C certificate. Have one of the teachers to step in if Helen is not around. At any time if possible, a staff member should accompany the First Aid Attendant in case further assistance is required.
b) If the scenario warrants it, accompany the student to the nearest clinic (Dr. Thomas Peters, 1816 West Broadway, 736-1888).If an x-ray is required due to a head injury or possible broken bones, the student should be taken to the nearest hospital or clinic with x-ray facilities.
Nearest Hospital:
Vancouver Hospital
855 West 12th Avenue, Vancouver, BC
Ph. (604) 875-4111Nearest Clinic:
Dr. Thomas Peters
1816 West Broadway, Vancouver, BC
Ph. (604) 736-1888Nearest Clinic with x-ray facilities:
Broadway-Arbutus X-Ray Centre
#390-2184 W. Broadway, Vancouver, BC
Ph. (604) 731-2200c) All students should have up-to-date Carecards or medical insurance coverage. However, in the event that a student has lost or forgotten it, or their card has expired, the student must pay the cost up front and ask the BC Health Services for reimbursement.
d) If the student cannot pay the fee at that time, ask the clinic or hospital to invoice Century High School and the student will have to pay the school at a later date.
3.4 Major Medical Incidents and /or Trauma
a) If any student or staff member falls unconscious for more than a minute, have the receptionist or another staff member call 911 and ask for an ambulance. Then have the First Aid Attendant paged. Please wait on scene with the victim to monitor the victim’s condition and offer the Attendant relevant information and assistance.
b) If any student or staff member is unable or unwilling to treat the incident as a medical emergency, have the receptionist or another staff member page the First Aid Attendant. If the First Aid Attendant cannot be located promptly, call 911 and ask for an ambulance.
c) Big cuts, breathing problems and persons suffering from pain in the chest are to be considered as major medical emergencies. Have the receptionist call 911 for an ambulance then have the First Aid Attendant paged. Remain with the victim.3.5 Medical Incidents Occurring Outside The Building or Nearby:
a) Don’t move the victim, unless he/she is in immediate danger. Ask a responsible person to go back to the school and have the receptionist page the First Aid Attendant. Have the messenger accompany the Attendant back to the victim. Remain by the victim for safety reasons and to monitor his/her condition. If the attendant cannot be located, have a teacher paged instead.
b) In case of any car accidents or major medical emergency in which a staff member or student has been injured, have a responsible person report back to the school and ask the receptionist to call 911 for an ambulance. Then have the First Aid Attendant paged and accompanied back to the accident scene. Remain with the victim(s).
3.6 Medical Incidents Occurring during Field Trips and Student Activities:Refer to the section on “Field Trips” in the Staff Handbook and apply the procedure as per Section #3.5 above. The staff member(s) with First Aid training will carry a First Aid Kit with them. In the event of a medical emergency, the First Aid trained staff member will assess the situation and take the appropriate measures.
In the event a student must be taken to the hospital, a staff member will contact the office and have the office contact the student’s emergency contact person.
3.7 Medical Incidents Occurring During PE Lessons
a) The PE teacher should always have the following items when teaching:
- First Aid Kit containing plenty of ice packs, bandaids and material for minor or medium size wounds and injuries
- A cellular phone.
- Copies of the accident reports.
- The attendance sheets (in the event of a fire or any other event requiring evacuation of a building, once the group has reached safety the PE teacher should take attendance to make sure everyone is present).
- Students’ medical numbers (insurance or carecard)
- The address and phone number of where the class takes place.
b) To minimize the risk of injuries, before each class, the PE teacher should:
- Make sure the environment is safe for the students.
- Make sure the students are dressed in a form appropriate to the activity.
- Make sure the students participate in a large muscle activity to increase body temperature and warm-up the muscles.
- Make sure the students are involved in a physical activity appropriate to their medical conditions.
- Allow some time for stretches.
c) Action to take if an incident occurs:
Step 1: Assess general situation
a) Student can be treated on the scene by his/her teacher
b) Student needs medical attentionIf the student can be treated on the scene, the PE teacher takes care of the injured student and asks the PE assistant to look after the rest of the group. Depending on the nature of the injury, an accident report should be filled out.
If the student needs medical attention, proceed to Step 2.
Step 2: Assess Severity
a) Student needs to be transported in an ambulance.
b) Student can be transported in a car.If the student needs to be transported in an ambulance the PE teacher should:
- Call 911 and ask them to send an ambulance.
- Ask the PE assistant to look after the rest of the group.
- Notify the school and ask them to send the student’s advisor to the hospital (the injured student should be sent to the nearest hospital).
- Fill out an accident report.
- Follow-up on the situation.
If the student can be transported in a car, the PE teacher should:
- Call the school and ask the student’s advisor to pick the student up and give him/her a ride to the nearest hospital.
- Ask the PE assistant to look after the rest of the group.
- Administer First Aid while waiting for help to arrive.
- Fill out an accident repot
- Follow-up on the situation.
4. Fire
a. The alert for fire will be the ringing of the fire alarm bell.
b. As soon as the alarm sounds, please identify one student in your class to be the last person out of the room and to turn off the lights and close the door.
c. Then lead your class out of the building, following the escape route designated on the map posted in your room. Be sure to take your daybook with you.
d. If you are not teaching at the time of the alarm, please report to the fire warden, Ella Jin. You may be asked to check one of the floors to make sure there are no students left behind and that the lights are off and the doors are all close.
e. When you reach the designated area please insist that your class stay with you and stay away from the school building. The designated assembly area is the front of Future Shop on West Broadway.
f. Check the attendance according to your daybook and then report to the Principal or designate.
g. Please remain with your class until permission is given by the Principal, or designate, to return to the building.5. Earthquake Preparedness
Earthquakes happen with no warning; therefore, life-protecting actions must be taken at the first indication of ground shaking. Even in the most severe earthquakes, buildings rarely collapse completely. Injury and even death are most often caused by the shattering and falling of non structural elements such as window glass, ceiling plaster, lighting fixtures, chimneys, roof tiles, and signs. Information in this section is taken from the guide: School Earthquake Safety Guidebook published by the BC Ministry of Education. All school members are strongly encouraged to read the guide. Further earthquake preparedness information can also be found on the following website:
http://www.pep.bc.ca/hazard_preparedness/earthquake_preparedness.html.Earthquake Drills
During an earthquake, there will not be time to think about what to do; therefore, of all earthquake-preparedness, EARTHQUAKE DRILLS ARE THE MOST IMPORTANT.Earthquake drills should occur separately from, but with the same frequency, as fire drills, i.e. at least once per semester. Drills should simulate natural conditions, i.e. emergencies such as jammed doors, blocked hallways and stairways. They should take place both inside and outside of the school, with and without prior warning of the drill. Indoors or outdoors, TAKE ACTION AT THE FIRST INDICATION OF AN EARTHQUAKE.
In the Classroom
The following are recommended earthquake procedures for a teacher and class of students. On given the signal for the drill:
- TAKE COVER under desks or tables
- FACE AWAY from windows
- ASSUME “CRASH” POSITION on knees, head down, hands clasped on back of neck or head covered with book or jacket
- COUNT ALOUD to 60 – earthquakes rarely last longer than 60 seconds and counting is calming.
The teacher should:
- Issue the “TAKE COVER” order
- Also take cover for 60 seconds
- Review evacuation procedures
If the teacher is injured, two student monitors should have designated authority to give instructions. Teachers should assign student monitors for each course at the start of every semester.Other Areas of the School
In other areas of the school, such as the computer lab, open study area, washrooms, hallways, or photocopier room, at the first sign of an earthquake, occupants should:
- Move away from windows, shelves and heavy objects that may fall.
- Take cover under a table or desk, in a corner or doorway.
- In halls, stairways and other areas where no cover is available, move to an interior wall, kneel with back to wall, place head close to knees, clasp hands behind neck, and cover side of head with arms.
- In the study area, move away from where books and bookshelves may fall and take cover.
- Stay inside – usually the most dangerous place is just outside where building debris may fall; exit only after shaking has stopped.
- In science laboratories, extinguish all burners, if possible, before taking cover; stay away hazardous chemicals that may spill.
Outside the School
- In other areas outside the school building, such as the patio, field trips, or other activities, students and teachers should move to an open space away from buildings and overhead power lines; lie down or crouch because legs will be unsteady; and look around to be aware of dangers that may require movement.
- On the school bus, the driver should stop the bus away from power lines, bridges, buildings, and overpasses; occupants should remove heavy objects from overhead racks, stay in seats, and hold onto the seat in front.
After an earthquakeAfter an earthquake, building evacuation should occur as soon as possible, due to the possibility of aftershocks, building collapse, fires, and explosions.
Students should:
- EVACUATE the building in single file when instructed by the teacher, principal, or designate.
- KEEP CALM.
- WEAR SHOES.
- DO NOT USE an elevator.
Teachers should:
- INSTRUCT students to evacuate when all shaking has stopped.
- LEAD CLASS to the designated assembly area.
- BE PREPARED to choose an alternative escape route in case of fire or exit blockage.
- TAKE class list, ID tags, first aid kit.
- APPLY ID information to all injured students, or students under age 19.
- GIVE FIRST AID, if necessary.
- DO NOT RE-ENTER the building unless instructed by the principal, or designate.
Copies of the standard drill procedures should be given to each teacher to implement in the classroom. Teachers should be aware of the nearest safety exit to their classroom, and inform students of the nearest exits at the start of every semester, and regularly thereafter.Discussion and Projects
Earthquake drills should be preceded by classroom discussions. These should be about the need for and purpose of drills. Teachers should dispel myths such as “the earth will open up and swallow you”. The contents of the guide School Earthquake Safety Guidebook may be used to explain what to expect, what to do and why.
The noises of building movement, windows breaking, and objects falling, that accompany an earthquake, can cause emotional stress and panic. Students should be prepared for this by classroom discussion.Student can carry out projects that are both useful and educational; for example:
- Prepare an earthquake safety kit to be kept near the exit door, students can suggest contents, e.g.:
– Copy of class list
– First aid supplies
– Flashlight and spare batteries
– Felt pen (for I.D marking)
– Games
– Plastic garbage bags for emergency protection.
– Portable radio and spare batteries - Students prepare their own emergency safety kit.
- Making posters describing what to do in the event of an earthquake.
- Identify hazards in the classroom, school, school grounds, neighborhood, and home.
- Illustrate the guide School Earthquake Safety Guidebook.
Evaluation
The school periodically evaluates the effectiveness of its earthquake drills. The following checklist may be used both for evaluation and in the initial planning of the drills:
- Have complete “quake safe” action drills been issued to all concerned?
- Are all students and staff familiar with the “TAKE COVER” procedure?
- Have students and teachers demonstrated their ability to take cover immediately?
- Do students know what to do in areas without a shelter?
- Do students stay quiet during drills?
- Are teachers able to maintain relative calm and reassure their students?
- Do students and teachers know and understand evacuation procedures?
- Does everyone know the location of the safe evacuation assembly area?
- Do teachers remember to take their class list and evacuation checklists to the assembly area after evacuation?
- Have other staff members practiced their roles during earthquake drills?
- Have emergency variations been practiced (e.g., exits blocked, aftershocks occurring, etc.)?
- Have students had ample opportunity to discuss their fears and concerns about earthquakes, including how they can help each other?
- Have parents been informed about the earthquake drills?
- Have the drills been extended into the family and home?
6. Essential First Aid in School
Aim of First Aid:
1. To preserve life
2. Prevent worsening of any injuries
3. To promote recoveryPlanning for an Emergency – First Aid Supplies/Records/Information in Main Office
1. Keep medical records – each student should provide the school with any medical conditions / food allergies he/she might have.
2. Have emergency supplies on hand (in the bottom drawer of the 2-drawer cabinet besides Helen’s desk).
3. Incident Report – Complete incident report regarding anything serious. To be found in First Aid Binder on the bookshelf at Helen’s desk.
4. Know the nearest medical center.
5. Know the route to the nearest hospital.
6. Have easy access to the Emergency Preparedness Manual (in First Aid Binder, on the bookshelf of Helen’s desk).Preparing for an Outside Trip
Note: When preparing outside visit or field trip, be prepared for any potential problems. Here are some things worth bearing in mind:
1. Know the number of students that you are responsible for.
2. Check out a place before going. For example, check any trails before you go hiking, wear appropriate clothing.
3. Be aware of any medical conditions that students might have.
4. Be aware of nearest medical center.
5. Have a schedule in mind.
6. Do not deviate from original plan without some thought.
7. Make sure trip is communicated well to students. As students are ESL, best to use both verbal and written instruction. Inform them of schedule, meeting places, etc.
8. Always remember that the group consists of students. Do not assume that they will always act as adults!School Incidents that can involve First Aid
This is not meant to be alarmist but the most dangerous school incidents occur because of the following:
1. Heights Be careful to check out any potential risk areas 2. Water Be careful to check out water hazards (depth, hidden rocks, tides, which students can a\swim, etc) 3. Dangerous activities Inform students of activities that are dangerous; for example, doing somersaults while skiing could result in serious injury) 4. Traffic Accidents As driver / pedestrian 5. Fighting Bullying at school 6. Bear attacks Be aware of bear areas, inform students of procedure 7. Food Poisoning Eating at school, eat out, undercooked food 8. Allergies Students should notify school of food allergies 9. Medical conditions Asthma, diabetic, etc. – students should notify school of any conditions they have 10. Sunstroke Advise students to protect themselves; provide sunblock for outdoor activities 11. Wasp stings / Snake bites Take insect spray to outdoor trips 12. Fire Be aware of smoking, inflammable material, etc. 13. Earthquake Be aware of emergency procedure 14. Anything Missed? Potential Accidents that could occur in schools:
1. Concussion (Head injuries)
2. Strikes and Collisions (broken Limbs)
3. Cuts and tears
4. Foreign Bodies
5. Burns
6. Choking
7. Serious Bleeding
8. Shock
9. Poisoning
10. Drowning
11. Hypothermia
12. Allergies (Asthma)
13. Sunstroke
14. Anything missed?I. Concussion (head injuries)
Symptoms:
- Brief or partial loss of consciousness following a blow to the head
- Dizziness or nausea
- Mild, generalized headache
What to do?
1. Ask the student his/her name. Assess response.
2. Watch carefully for any deterioration in the level of response.
3. Place victim in care of responsible person. Do not allow them to “play on” without approval of doctor.
4. Take / Advise victim to go to medical center if headache or nausea continues.
5. Place unconscious victim in the recovery position. Monitor and record breathing, pulse, and level of response every ten minutes.II. Strikes and Collisions (broken bones)
Symptoms
- The victim felt or heard a bone snap.
- The site of the injury is painful or tender, particularly when touched or moved.
- Victim has difficulty moving injured part.
- Discoloration, swelling, deformity
What to do?
1. Sit or lay the victim down
2. Support the injured area (Make a splint, put pillows either side)
3. Call 911 (or medical assistance)Note: If you suspect a neck or spinal injury, do not move the victim unless she is in great danger, or the airway is blocked (see ABC).
III. Cuts and TearsWhat to do?
1. Wash your hands thoroughly with soap and water handling wound.
2. If cut is still bleeding, apply direct pressure over wound with sterile or clean cloth.
3. When bleeding has stopped, wash wound thoroughly.
4. Rinse wound under running water for 5 to 10 minutes.
5. Pat wound dry with sterile or clean cloth.
6. If bleeding is severe, use direct pressure to control bleeding (See Serious bleeding below). See medical help.IV. Foreign bodies
What to do?
1. Small foreign bodies such as wood splinters usually cause minor puncture wounds with little or no bleeding. If a portion of the object protrudes from the skin, you may attempt to remove it.
2. If a foreign body is deeply embedded in a wound, do not remove it; you may cause further injury by doing so. Seek medical assistance.V. Burns
Symptoms
- Redness, Swelling, tenderness
- Blisters, moist oozy appearance, swelling (more serious)
What to do?
1. Determine degree of burn. If first degree, will not usually require medical assistance. A third degree burn will require urgent medical attention.
2. Put the burned area under cool running water, or apply a cool water compress (a clean towel or handkerchief soaked in cool water) until pain decreases.
3. Cover burn with nonfluffy sterile or clean bandages. Do not apply butter or grease to a burn.
4. If more serious, also remove jewelry. Elevate burned arms or legs. Seek medical help immediately.VI. Choking
Symptoms
- Difficulty in breathing and speaking
- Distressed signs from victim
What to do?
1. If coughing, encourage them to continue coughing. This may dislodge the obstruction.
2. ONLY if the victim cannot breathe: Heinlich Maneuver (abdominal thrust). Stand behind the person and put your arms around him/her. Link your hands below the ribcage and pull sharply inward and upward. The force of the thrust may expel the obstructing object.
VII. Serious bleedingExternal
What to do?
1. Remove or cut clothing to expose the wound. Watch out for sharp objects, such as glass, that may injure you.
2. Apply direct pressure over the wound with your fingers or palm, preferably over a sterile dressing or clean pad (if nothing is stuck in the wound).
3. Raise and support an injured limb above the level of the heart.
4. Lay the victim down. This will reduce blood flow to the site of injury, and minimize shock.
5. Secure and support the injured area with bandaging (not so tight that it cuts off circulation).Internal
Symptoms
- Pallor
- Cold, clammy skin
- A rapid, weak pulse
- Confusion, irritability, unconsciousness.
What to do?1. Help victim lie down, and raise and support his/her legs. Loosen clothing at the neck, etc.
2. Dial 911 / Seek medical assistance immediately.VIII. Shock
Symptoms:
- A rapid pulse (at first)
- Pale, gray – blue skin
- Sweating
- A weak, ‘thready’ pulse (gets worse)
- Nausea
- Rapid, shallow breathing
- Restlessness, anxiousness, leading to unconsciousness
- Confusion, difficulty speaking/expressing themselves
What to do?1. Treat any cause of shock you identify (such as external bleeding)
2. Lay victim on blanket to protect him/her from cold ground, keeping his/her head low. Constantly reassure the victim.
3. Raise and support legs to improve blood supply to vital organs.
4. Loosen clothing such as belts, to reduce constriction at neck, chest and waist.
5. Keep her warm. Dial 911 / Seek medical assistance.IX. Poisoning
What to do?
1. Check and if necessary, clear the victim’s airway.
2. If the victim becomes unconscious, check breathing and pulse, and be prepared to resuscitate if necessary (see ABC). Place the victim in a recovery position.
3. Dial 911 / Seek medical assistance …OR…
4. Call the Poison Control Centre, BC Health Units, at 604-736-2033.X. Drowning
What to do
1. This is a case where the First Aid Attendant has to be aware of his/her own personal safety. The first thing to do is to assess the danger. Ideally, give the victim something to hold (e.g. a piece of clothing) and pull him/her to the shore. Do not enter the water if it is a danger. Seek help.
2. Lay victim down on a coat or rug. Open the airway, check breathing and pulse, and be prepared to resuscitate if necessary (see ABC)
3. Treat victim for hypothermia. Remove wet clothing and use coat/blanket to protect him/her from cold.
4. Place in recovery position. If he/she regains consciousness, you can give victim hot drinks.
5. Dial 911 / Seek medical assistance.XI. Hypothermia
Symptoms:
- Shivering, and cold, pale, dry skin
- Apathy, disorientation, or irrational behaviour. Failing consciousness
- Slow and shallow breathing
- Slow and weakening pulse
What to do?
1. Insulate the person with extra clothing or blankets, and cover his/her head.
2. Protect the person from ground and elements.
3. Take to sheltered place (or send for help. Do not leave victim alone).
4. If person becomes unconscious, use ABC.XII. Allergies (Asthma)
Allergies can take many forms:
Respiratory Allergies (Asthma Attack) – If the person has Asthma medication, you can get it for him/her and ask him/her to take it. You cannot administer it for the victim – only he/she can give it to himself/herself.Symptoms:
- Difficulty breathing, with a very prolonged breathing-out phase
- Wheezing, distress, anxiety, etc. Rarely, he/she may become unconscious.
What to do?
1. Keep calm and reassure the person. A reliever inhaler usually works within a few minutes.
2. Let person adopt the position that he/she feels most comfortable (eg: sitting down)
3. If the attack does not ease, call 911 / Seek medical assistance.XIII. Sunstroke / burn
Symptoms
- Skin is lobster-red and blistered
- Pain, mild swelling, itching, shivering
What to do?1. Put cold water on the sunburned area
2. If sunburn is severe, submerge the sunburned area under cold water until pain is relieved.
3. Seek medical help if severe.ABC (Resuscitation techniques)
After checking the response of the victim, it would be necessary to do the following if that person is clearly unconscious:
Airway
Check the airway if open. Place two fingers under the point of the person’s chin, lift the jaw. At the same time, place your other hand on the person’s forehead, and gently tilt the head back.
Kneel beside the victim, and put your face close to his/her mouth. Look, listen, and feel for breathing.
1. Look along the chest to see if the chest rises, indicating breathing.
2. Listen for sounds of breathing
3. Feel for breath on your cheek.Do these checks for ten seconds before deciding that breathing is absent.
Breathing
1. Close the nose by pinching it with your index finger and thumb. Take a full breath, and place your lips around the mouth, making a good seal.
2. Blow into the mouth until you see the chest rise. Take about two seconds for full inflation.
3. Remove your lips and allow the chest to fall fully, which takes about four seconds. Repeat this once and then assess for signs of circulation.If the pulse is absent and there are no signs of recovery, CPR is necessary.
Circulation
1. Perform chest compressions by pushing vertically down on the breastbone. Lean well over the victim, with interlocking fingers, arms straight, press vertically down and then release, compress the chest 30 times, “Push hard, push fast” (rate of 80-100 compressions per minute).
2. Then give 2 breaths of artificial respiration.
3. Continue this cycle of alternating 30 chest compressions with two breaths of artificial respiration until help arrives.Recovery Position
An unconscious person should be placed in the recovery position. This position prevent the tongue from blocking the throat, and allows liquid to drain from the month.
What to do?
1. Kneel beside the person. Open his/her airway by tilting the head and lifting the chin. Straighten his/her legs. Take the arm nearest you and raise it above his/her head.
2. Bring the arm furthest from you across the chest, and hold the back of the hand against the person’s nearer cheek. With your other hand, pull up the far leg just above the knee, keeping the foot on the ground.
3. With one hand on the person’s shoulder, use your other hand to pull on his/her waist to roll the person toward you and onto his/her side.
4. Adjust upper leg to help support the person on his/her side.
5. Tilt head back to ensure airway remains open. If necessary, adjust the arm under the cheek.
6. Adjust upper arm until person is in a stable position.
EMERGENCY INCIDENT REPORT
This form is to be used for reporting all incidents of serious emergency at Century High School. Complete and submit to the Director of Admissions within 24 hours of the incident. Please print clearly. Replicate this form or use additional pages if necessary.