Battle Roster # - Write first letter of casualty’s first name, then first letter of casualty’s last name, then write the last four numbers of casualty’s Social Security number. For example, John Doe 123-12-1234 is Battle Roster # “JD1234”.
Evacuation (EVAC) - Mark an “X” on the casualty’s evacuation priority/precedence (Urgent; Priority; or Routine).
Name - Write casualty’s name (Last, First).
Last 4 - Write last four numbers of casualty’s Social Security number.
Gender - Mark an “X” on the casualty’s gender (Male (M) or Female (F)).
Date - Write date of injury in DD-MMM-YR format. For example, “29-JUN-13”.
Time - Write 24-hour time of injury, and indicate whether local (L) or zulu (Z) time. For example, “1300Z”.
Service - Write casualty’s branch of service (USA, USAF, USCG, USN, USMC). For U.S. civilians, write “US CIV”. For non-U.S. personnel, write “NON US” or a standard abbreviation for casualty’s nationality.
Unit - Write casualty’s unit name.
Allergies - Write casualty’s known drug allergies. If no drug allergies, write “NKDA” (no known drug allergies).
Mechanism of Injury (MOI) - Mark an “X” on the mechanism or cause of injury (artillery, blunt, burn, fall, grenade, gunshot wound (GSW), improvised explosive device (IED), landmine, motor vehicle crash/collision (MVC), rocket-propelled grenade (RPG), other (specify)). Mark all that apply.
Injury - Mark an “X” at the site of the injury(ies) on the body picture. For burn injuries, circle the burn percentage(s) on the figure. If multiple mechanisms of injury and multiple injuries, draw a line between the mechanism of injury and the anatomical site of the injury.
TQ: R Arm (tourniquet, right arm) - If a tourniquet is applied to the right arm, write type of tourniquet used and the time of tourniquet application.
TQ: L Arm (tourniquet, left arm) - If a tourniquet is applied to the left arm, write type of tourniquet used and the time of tourniquet application.
TQ: R Leg (tourniquet, right leg) - If a tourniquet is applied to the right leg, write type of tourniquet used and the time of tourniquet application.
TQ: L Leg (tourniquet, left leg) - If a tourniquet is applied to the left leg, write type of tourniquet used and the time of tourniquet application.
Time, Pulse (rate & location), Blood Pressure, Respiratory Rate, Pulse Ox % O2 Sat, AVPU, Pain Scale (0-10) - Record vital signs (pulse rate and location, blood pressure, respiratory rate, oxygen saturation), level of consciousness (AVPU: Alert, responds to Verbal stimulus, responds to Pain stimulus, Unresponsive), and level of pain (on numeric rating scale of 0 to 10, with 0 being no pain and 10 being the worst pain) with time.