Chirurgeon Event Report

Middle Kingdom Chirurgeon Event Report

THIS REPORT GOES TO
Constellation Regional Midlands Regional Oaken Regional Pentamere Regional

SCA Name:
Legal Name:
Street Address:
City, State, Zip:
Phone:
Email Address:	(A copy of this report will be emailed to your email address)
SCA Membership #:
SCA Membership Expiration:

EVENT INFORMATION

Event Name:
Event Date:
Event Location:
Marshal In Charge:
Chirurgeon In Charge:
Event Attendees:
Number of Heavy Fighters:
Number of Rapier Fighters:
Weather and Conditions:

WARRANTED CHIRURGEONS

Name Home Group

CHIRURGEONS-IN-TRAINING OBSERVED
(Be sure to submit Chirurgeon-in-Training evaluations after submitting this form)

Name Home Group

INJURIES

NO INJURIES (Really, nothing happened)

MINIMAL INJURIES (Treated on-site, unlikely to need medical followup)

Heavy Rapier Kitchen Camping Dancing Bystander Other

# Band-Aids

Over-the-Counter Meds

Mild Heat Injury:

Contusions/Abrasions:

Musculoskeletal:

Burns:

Splinters/FB:

Substance Abuse

Other

MODERATE INJURIES (Treated on-site and requiring medical follow-up)

Heavy Rapier Kitchen Camping Dancing Bystander Other

Fractures

Dislocations

Lacerations:

Unconsciousness

Burns:

Environmental

Medical

Substance Abuse

Other

SERIOUS INJURIES Injuries requiring immediate transport and treatment and/or treatment of minors
No Serious Injuries
There were Serious Injuries. An Incident Report has been filled out and will be submitted separately

Comments: