Event Report

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Meridian Chirurgeon Event Report Form s_fleam2.bmp (67854 bytes)

to be filed within Two (2) weeks post-event

Personal Copy Kingdom Chirurgeon Autocrat Marshall

Keep a copy for your records, send a copy to the Kingdom Chirurgeon, send a copy to the Autocrat, and a copy to the marshall in the event of a fighting related injury.

    C.I.C.   _____________________________ ________________________________
                                     SCA Name                            Legal Name
    Event    ______________________________________   Date ____/____/_______

Location _____________________________ Host Group _____________________

    Autocrat _____________________________ ________________________________
                                     SCA Name                            Legal Name
    Marshall _____________________________ ________________________________
                                     SCA Name                            Legal Name

Estimated Site Census ___ Chirurgeon Census ___ Waterbearer Census ___

Weather Conditions Day Night

Hot / Cool / Cold Hot / Cool / Cold

Wet / Dry Wet / Dry

`Total patient contacts for event`
`Adult`		`Pediatric`
`Medical`
`Trauma`
`Ambulance Tx`
`Totals`