Lifeguard Secondary Assessment Checklist Form
Complete this checklist to document a lifeguard secondary assessment, observed conditions, actions taken, and follow-up notes.
Incident Context
Date and Time of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location / Area of Incident
*
Please Select
Main Pool
Shallow End
Deep End
Water Slide Area
Dive Area
Wave Pool
Lazy River
Hot Tub / Spa
Beachfront
Other
Water / Activity Conditions
Calm water
Rough water / waves
Crowded area
Low visibility
Pool rules violation
Swimming lesson in progress
Recreational swimming
Diving activity
Water slide use
Other
Incident Summary / Reason for Assessment
*
Secondary Assessment Checklist
Observed Signs and Symptoms / Condition Checks
*
Overall Concern Level
*
Low concern
1
2
3
4
5
6
7
8
9
High concern
10
1 is Low concern, 10 is High concern
Notable Observations
Current Status
*
Stable and improving
Needs continued monitoring
Requires escalation
Actions and Follow-Up
Actions Taken
*
Follow-Up / Monitoring Notes
*
Submit
Should be Empty: