Sea Urchin Spine Injury Assessment Form
Please complete this form to document and assess the details of a sea urchin spine injury incident.
Date and time of incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of incident (e.g., beach name, pool, etc.)
*
Brief description of how the injury occurred
*
Injury location on body
*
Please Select
Foot
Hand
Leg
Arm
Other
Severity of pain at the time of injury
*
No pain
1
2
3
4
5
6
7
8
9
Severe pain
10
1 is No pain, 10 is Severe pain
Symptoms experienced
Swelling
Redness
Bleeding
Numbness or tingling
Difficulty moving affected area
Other
Number of visible spines remaining in the wound (if any)
First aid performed before this assessment
Rinsed with fresh water
Removed visible spines
Applied antiseptic
Applied heat
No first aid performed
Other
Is professional medical evaluation being sought?
*
Yes
No
Undecided
Additional comments or observations
Submit Assessment
Should be Empty: