Burn Wound Evaluation Checklist
Patient Name
Evaluation Date
Burn Details
Location of Burn
Burn Size (Total Body Surface Area, %)
Burn Depth
Superficial (1st degree)
Partial Thickness (2nd degree)
Full Thickness (3rd degree)
Deeper (4th degree)
Type of Burn
Thermal
Chemical
Electrical
Friction
Radiation
Other
Assessment
Appearance
Sensation
Blistering
Present
Absent
Eschar
Present
Absent
Exudate/Drainage
Odor
Circulation
Capillary Refill
Normal
Delayed
Pulses Distal to Burn
Palpable
Not Palpable
Additional Notes