ABCDEFGHIJKLMNOP
1
Timestamp
What is your room number?
How many people including yourself are in the room?
What is your name?
List the names of the people who are with you that are not normally with you.
List the names of people who would normally be with you but are missing.
Is anyone injured?
Are injuries life threatening?
List types of injuries
Is there any other information you feel officials should know?
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100