CONFIDENTIAL: Please do not distribute or reproduce without permission.
APPENDIX A INTERNAL USE
Girl Scouts Carolinas Peaks to Piedmont CONFIDENTIAL CRISIS REPORT: PART l This confidential report is used to record all information concerning major emergencies, serious accidents or fatalities. Copies of this report should be sent or hand delivered to all members of the Crisis Team. Circulation of this information is limited, and copies should be distributed in sealed envelopes marked personal and confidential. DATE/TIME OF FIRST CALL OR REPORT PERSON WHO CALLED (Identify position) OR REPORTED INCIDENT TO YOU NAME TELEPHONE WHERE CALLING FROM TELEPHONE GIRL SCOUT PERSON AT THE SCENE NATURE OF EMERGENCY (accident, death, media item)
WHAT HAPPENED? (Be specific)
WHEN AND WHERE DID IT HAPPEN? – DATE/TIME/EXACT PLACE OF ACCIDENT
WAS THE PERSON TAKEN FOR MEDICAL TREATMENT? WHERE AND HOW?
NAME, AGES, ADDRESSES AND PHONE NUMBERS OF PEOPLE INVOLVED (If troop, include troop number, program age level, name of leader and indicate if member or nonmember.)
PARENTS’ NAME, ADDRESS OR ADDRESSES, PHONE NUMBER OR NUMBERS
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