Victim Extrication Form

⬇ Download Victim Extrication Form

Primary information

• Worksite ID
• UCC (only to be filled in when team operates directly under the UCC)
• SCC (mark the name of the sector the worksite is in)
• Victim #
• Extrication
  • Date and time
• Live?
  • Yes or No
• Reporting Team ID

Secondary information

• Floor level found
• Victim GPS Coordinates
• Handed over to
  • Locals/family
  • Field hospital
  • Ambulance
  • Helicopter
  • Hospital
  • Mortuary
  • Medical team
  • Other

Other relevant information

• For example: contact details of the person to whom the victim was handed over