Really, Absolutely Nothing Happened
Event _____________________________________________________________
Event Date __________________________ Hosting Unit __________________
Location __________________________________________________________
Marshall In Charge _________________________________________________
Chirurgeon In Charge _______________________________________________
Other Warranted Chirurgeons Assisting ________________________________
________________________________
________________________________
Apprentice Medics Observed _________________________________________
_________________________________________
_________________________________________
(Please attach Apprentice Evaluation forms)
___________________________________________________________________
Really, Absolutely Nothing Happened
Well, Almost Nothing Happened:
Fighting Related?
Gave out some bandaids Y
N
Gave out some ice Y
N
Fluids and rest
Y
N
Ace bandage
Y
N
Bumps and scrapes Y
N
TLC Y
N
Sunscreen Y
N
Sunburn lotion Y
N
Other Y
N
Recommendations __________________________________________________
Comments ________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
C-I-C Sig. (Legal Name) _____________________________________________
Address _____________________________________________
_____________________________________________
_____________________________________________
Mail to Kingdom Chirurgeon
THL Robert Marston
1219 Colfax St.
Pittsburgh PA 15212