Heatstroke Prevention Checklist
Complete this checklist to help prevent heatstroke and ensure safety in hot conditions.
Full Name
*
First Name
Last Name
Date and Time of Checklist Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Current Environmental Conditions
*
High temperature (above 32°C / 90°F)
Moderate temperature (25-32°C / 77-90°F)
Low temperature (below 25°C / 77°F)
High humidity
Direct sunlight exposure
Other
Which heatstroke prevention actions have you taken? (Select all that apply)
*
Drank water regularly
Wore light, breathable clothing
Took breaks in the shade or cool areas
Avoided strenuous activity during peak heat
Used sunscreen or protective gear
Monitored for symptoms of heatstroke
Other
Are you currently experiencing any of the following symptoms? (Select all that apply)
*
Heavy sweating or no sweating
Dizziness or weakness
Headache
Nausea or vomiting
Confusion or disorientation
Muscle cramps
None of the above
Contact Information (Phone or Email)
Submit Checklist
Should be Empty: