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Get and Sign Accident and Illness Report Form Ct
YCAccidIllness. Athletic field cabin mess hall etc. Supervision at the time of incident Adult staff CIT staff Other Describe Names of all camp staff who witnessed the incident License First Name Patient Last Name Patient chicken pox for rash or exposure to peanuts for allergy Allergy Asthma Rash Strep Throat Ear infection Food Borne Illness GI Illness Lyme Disease Viral Infection Name of staff member s illness was reported to Name of person s providing treatment for injury or illness i.e. camp...Show details
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