Seizure Observation Log printable pdf download

Seizure Observation Log

This form is designed to be used for general communication between direct care staff, supervisory staff, legal representatives and

medical professionals to support the well-being of people who may experience a seizure. All sections should be completed for each

seizure that occurs.

Name of Person ______________________________________ Age or Date of Birth ____________

Lastname (please print), Firstname (please print)

Date

Time

Length of

Seizure

Recovery

Comments

Name of Person

(if any)

Seizure

Observations*

Observations

Making the entry

(seconds or

(You can use numbers below)

(please print)

minutes)

*Possible observations include:

1. Sudden Stare

4. Sudden onset nausea

7. Gradual recover (minutes)

10. Unconsciousness

2. Unresponsive to name

5. Vision problems

8. Stiffening, convulsive activity

11. Slow recovery (confused & needing sleep)

3. Prompt recovery (seconds)

6. Jerking of a limb

9. Laboured breathing

Seizure Observation Log