

I have Word document that I think people would want to print. Is there a way to post it in this forum? I noticed it didn't paste like I copied it. Maybe copying it and pasting it in Word would work, but I'm just a 29th year apprentice. It's a full 8-1/2 X 11 page. It's a modification of a handout I got from one of the OSHA inspectors at a seminar I attended. You can put your company name and phone number on the line below the title. I thought you could put a copy in the first aid kit and one in the arc flash kit. Printed on card stock would be nice, so you don't have to find something solid to write on during an emergency. Hopefully you will never have to use it. Let me know if I should just start a thread in the Safety area. Thanx.
Electrical Accident Victim Checklist
__________________________________________________ _______________________________
To the attending care provider: This information sheet and checklist is being provided to assist in determining the potential seriousness of an electrical incident, either electrical shock, arc flash or arc blast. Please be aware that the extent of the victim’s injuries may be worse than first clinically apparent.
1. Name of victim __________________________________________________ ___________________________
2. When did accident occur? __________________________________________________ ___________________
3. Where did accident occur? __________________________________________________ __________________
4. How did accident occur? __________________________________________________ ____________________
5. What was victim doing? __________________________________________________ _____________________ __________________________________________________ _________________________________________
6. Was the victim involved in an arc blast? ______________Yes / No
7. Was the victim involved in an arc flash? ______________Yes / No
8. Was the victim in direct contact with electricity? _______Yes / No
a. Did the victim require defibrillation? __________Yes / No
b. Did the victim require CPR? _________________Yes / No
c. What was the probable voltage level? ________________Volts
d. What was the probable path through the body? From __________________to ____________________
e. Estimated duration of direct contact. __________________________________________________ ___
f. What was the condition of the body at the point of contact? Dry _________ Sweating ___________ In contact with water ___________ Skin openings (cuts, scrapes, punctures) _____________________ Other __________________________________________________ ____________________________
9. Did the victim fall? _____________________________Yes / No
10. Did the victim lose consciousness? _________________Yes / No
11. Did the victim seem dazed or confused? _____________Yes / No
12. Were any other hazards noticed in the vicinity of the accident? _______________________________________ __________________________________________________ ________________________________________
13. Circle noted injuries and locations:
a. Cuts __________________________________________________ _____________________________
b. Burns __________________________________________________ ____________________________
c. Bruises __________________________________________________ ___________________________
d. Bumps __________________________________________________ ___________________________
e. Broken bones __________________________________________________ ______________________
f. Vision Problems __________________________________________________ ____________________
14. Who has more information? __________________________________________________ _________________