| General Incident Information |
|
Type of Incident |
Injury
|
|
Incident
Event |
Stove Burn |
| Date & Time Information |
|
Date
Course Started |
12/12/2008
|
|
Incident Date |
12/15/2008
|
|
Incident Time of
Day |
12:30 PM
|
|
Total Days of Course |
6
|
|
Total
Active Hours of Course |
33
|
|
Day
of Program Incident Occurred |
Day
2
|
|
Activity & Environmental
Information |
|
Type of Activity |
Cooking
|
|
Type
of Environment(s) |
|
|
Environmental Condition(s) |
|
|
Weather Condition(s) |
|
|
Contributing
Factor(s) |
|
|
Narrative |
|
|
Assessment/Treatment |
|
|
Analysis |
|
| |
Date Submitted
|
February 17, 2008
|