• Date

• Day/Time

• Scenario

• Lifeguards on duty

• Elements of the rescue

(Include whether the lifeguard(s) and emergency team members were successful or unsuccessful in a particular element. Include comments as appropriate)

§ Lifeguard rescue ready

§ Victim recognized

§ Lifeguard activated emergency action plan

§ Lifeguard performed a safe and successful entry and in-water rescue as necessary

§ Emergency back-up surveillance coverage provided

§ Lifeguard used appropriate in-water rescue equipment

§ Lifeguard safely removes victim from the water

§ Lifeguard provided adequate victim assessment

§ Lifeguard provided appropriate care

§ Lifeguard used appropriate personal protective equipment

§ Emergency team responded appropriately

§ Emergency equipment (AED, O2, etc.) was available and usable within XX minutes

• Overall Remarks