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PART I: Illness and Injuries (check all that apply)

PART I: Illness and Injuries (check all that apply) 2025

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The document is a comprehensive health history and permission form for a Girl Scout participant. It includes sections for detailing the participant's medical history, allergies, other health conditions, immunization records, and permissions for participation in activities. Parents or guardians are required to provide information about their child's health status, emergency contacts, and consent for medical treatment and media use. The form emphasizes the importance of safety and preparedness for various activities within the Girl Scouts.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your daughter’s name at the top of the form. This personalizes the document and ensures clarity.
In the section labeled 'Chronic or recurring illness', check all applicable boxes for any illnesses your daughter has experienced, such as asthma or diabetes.
Provide the date of your daughter’s last examination in the designated field to keep her health records up-to-date.
Answer the yes/no questions regarding complicating medical problems, current physician care, and any serious injuries or illnesses since her last exam. Be sure to explain any 'yes' answers in the space provided.
If applicable, note any restrictions concerning physical activity to ensure proper care during activities.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (127 Votes)
2019	4.4 Satisfied (129 Votes)
2017	4.2 Satisfied (50 Votes)

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Which of the following are injuries or illnesses that must be reported to OSHA by an employer?

Any work-related injury or illness requiring medical treatment beyond first aid. Any work-related diagnosed case of cancer, chronic irreversible diseases, fractured or cracked bones or teeth, and punctured eardrums.

What is considered an injury or illness in OSHA?

Injury or illness. An injury or illness is an abnormal condition or disorder. Injuries include cases such as, but not limited to, a cut, fracture, sprain, or amputation. Illnesses include both acute and chronic illnesses, such as, but not limited to, a skin disease, respiratory disorder, or poisoning.