Illness Injury Evacuation Report

Illness/Injury/Evacuation Report

Form for guides in the event of an illness, injury, or evacuation.

Trip Departure Date
MM slash DD slash YYYY
Trip Type
Guide #1 Name
Guide #2 Name
Time of Incident

: Hours

Minutes

AM/PM
Date of Incident*
MM slash DD slash YYYY
Location of Incident*
Name of Injured Person*
Mechanism of Injury/Illness
Events of Incident
Please describe the events leading up to the injury/illness and what proceeded
CHIEF COMPLAINT (OPQRST)
ONSET
Provokes
Quality
Region/Radiation
Severity
Time Sequence
Objective Data (SAMPLE)
Symptoms (Patient Exam)
Allergies
Medications/Drugs
Pertinent Medical History
Last Oral Intake/Output
Assessment: Prioritized Problem List
Vitals
Please include each recording's exact time and the vitals recorded.
Please sign below with your initials in acknowledgement that everything you have submitted and reported is correct and complete.*
Comments
This field is for validation purposes and should be left unchanged.

Save and Continue Later

All content © 2024 The Mountain Guides. Terms of Privacy.

Website Designed & Built by TMBR — a Creative Agency.

Request a Guide

Requested Guide*
Client Name*
First Last
Email*
Phone
Trip of Interest
Requested Dates*
Additional Comments
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Locations
- Featured Adventure
  
  Women’s Climbing Weekend in the Red Rock
  
  This is the first of installment of The Mountain Guides’ “WOMEN’S NETWORK CLIMBING SERIES” Whether you are a new or experienced climber, The Women’s Climbing Network Series has a weekend course for you! We will be hosting these events at many of our different branches. Wherever you are in your climbing journey, The Mountain Guides […]
  Learn More
- Menu
- View All Adventures
- Branches
  - Locations
  - Jackson Hole
  - Colorado
  - Red Rock
  - Utah
  - Montana
  - International
- Locations
Adventures
- Featured Adventure
  
  Women’s Climbing Weekend in Moab
  
  THE WOMEN’S NETWORK Climbing Series heads to Moab. Spend two days with us on the warm sandstone of the desert as you hit the local classic crack climbs in the Moab area. You will learn the nuances and skills it takes to climb splitter cracks, taught by some of the best women/ non binary guides […]
  Learn More
- Menu
- View All Adventures
- Trip Types
- Locations
Education
- Featured Adventure
  
  City of Rocks – Women’s Weekend
  
  The City of Rocks, one of Idaho’s most incredible climbing areas, is the birthplace of The Women’s Network. It was launched in 1995 by Senior Guide Aimee Barnes. Aimee saw a need to create an event for women/ non-binary people who wanted to climb and connect with women/ non-binary climbers and guides. The City of […]
  Learn More
- Menu
- View All Adventures
- Education
- Locations
Gear
Experience
- Featured Page
  
  Videos
  
  The Mountain Guides Video Library is your go-to resource for everything you need to know about us, and about your trip. This is where we share personal stories, packing tips, gear recommendations and technical expertise. Better get watching!
  Learn More
- Menu
- Experience
- Admin
Blog
Contact