Heat Illness Incident Report
(Track & Field)
General Information
Date of Incident
Time of Incident
Location
Event/Activity
Athlete Information
Athlete's Name
Age
Team/School
Coach
Incident Details
Signs & Symptoms
Onset (How and when did symptoms begin?)
Environmental Conditions (Temperature, Humidity, etc.)
Clothing/Equipment Worn
Care Provided
Immediate Care (actions taken, fluids, cooling, etc.)
Was medical assistance required?
No
Yes
Was the athlete transported to a medical facility?
No
Yes
Follow-up action(s) recommended
Report Completed By
Name
Role/Title
Date