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"Ouch Report"

This form belongs in the public domain.

Unitarian Universalist Church of Valhalla

Use this form whenever you give first aid to a legal minor in your group, even if all you did was put on a band-aid.

Age group: ________________ Date and Time: _______________

Your name: ________________ Your co-teacher: _______________

Name of child to whom you gave first aid: ________________

What first aid did you have to give?


What incident happened that the child needed first aid? Please describe the incident briefly.


Who witnessed this incident?


____ Check here if you observed Universal Health Precautions.
____ Check here if you had to call 911.
____ Check here if you notified the parents/guardians by giving them a copy of this form.

Thank you for handling this incident!

____________ Date read by Director of Religious Education