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SLED SAFE - INJURY RECORD 3 <br /> CL Hill Name/Address(if any)of injury: Date of Injury(yy/mm/dd): Time of Injury(24 hour dock): _ pr <br /> Name/Position of Person Completing Report Date of Report(yylmrnldd): Time of Report(24 hr clock): O <br /> mPlease provide a brief description of the events leading to this injury: -,,Injured Partfis< . ... ;:A:. -D C <br /> 3 Name: <br /> V Phone Number. 0 = <br /> A HM Conditions at Time of Injury: Wearing Down to Grass or Mud: Address: 0 C <br /> Fresh Predpiladon wftW last 24 hrs [ ] Take off Area [ ] Age: a I <br /> C Fluffy Unpacked Snow on Runs ( ] Run Area [ ) Sex(Please drde) M/F MJF M/F CO) <br /> `Z Packed Snow on Runt; ( ] Run out Area [ 1 Sled Manufacturer&Model <br /> M Bumps/Jumps/Rough Areas on: ice on: Sled Equipment Type: <br /> Runs [ ] Take off Area [ ] (ie.TobogganNVood or <br /> IRun Out Area: [ ] Sled Run [ 1 To Aluminum <br /> Run-Oul Area [l Describe Injuries(le.cut lip,broken <br /> Ascent HWLa^e ( ] arm,unconscious <br /> Atmospheric Conditions at Time of Injury: Temperature °C Describe comfort provided to <br /> Sunny [ ] Clouded Over I I Sun and Cloud [ ] Injured party(iss)(le.kept warn) <br /> Lighting Conditions at Time of Injury: Describe First Aid Provided to <br /> Daylight Twill ht I I Dark Artificial Lightg LightInjured Party(kes) <br /> Wind Conditions at Time of Injury: Describe Follow-up Instruction <br /> None [ ] Gentle 0-6 kph [ ] Breeze 6.15 kph ( ] Provided to Injured Party(les)-If <br /> Strong 15-30 kph [ ] Gale 30 kph+( ] not taken to hospital by Emergency <br /> Services <br /> Precipitation: Who took the Injured party(les)to <br /> None I I Rain Sleet Wet Snow Dry Snow Hosprol <br /> Sketch the Accident scene(TAKE PICTURES),Attach to Report <br /> How did you find out about the injury?: Was Injured Party(les)supervised by an adult at the time of the injury? <br /> [ ]yes [ ]no Describe: <br /> Parents [ ] Group Leader[ ] Other Adult Relative[ ] Friend[] Siblings ( j <br /> Volunteer [ ] Teacher [ ] Staff ( ] Other(describe) <br /> What preventative actions were taken Immediately to ensure safety of <br /> other sledders?: <br /> Dot <br /> o What educadonlsupervis[onfinspecdonlmaintenence may be required to prevent future similar Injuries? <br />