Form

Abstract

 The invention relates to a form, wherein a strip is added to the form which is separably connected to the form and which is adapted to be arranged on and/or round a body part of a person.
The invention likewise relates to a form, wherein the form and the strip each comprise a preprinted image and/or identifier, these images and/or identifiers being identical to each other or having an unambiguous relation with each other.

Description

[0001] The invention relates to a form.

[0002] The invention relates more particularly to a form in the form of for instance a sheet of paper which can be used, for instance in the case of disasters, for filling in for instance personal data of persons involved in the disasters.

[0003] A drawback of such forms is that it is not clear whether a determined person has already filled in a form or whether this is precisely not yet the case. It can hereby occur that a person who has already filled in the form is asked unnecessarily whether he or she will fill in a form. This may for instance result in irritation on the part of the person in question. Furthermore, the time of emergency workers is hereby wasted, such time being valuable during disasters.

[0004] The invention thus has for its object to provide a form which does not have or at least partly obviates the above stated drawback, while its advantages are at least partly retained.

[0005] At least this object and/or other objects are achieved in that a strip is added to the form which is separably connected to the form and which is adapted to be arranged on and/or round a body part of a person. The form and the strip particularly each comprise a preprinted image and/or identifier, these images and/or identifiers being identical to each other or having an unambiguous relation with each other.

[0006] An advantage of the form according to the invention is that, for instance after the form has been completed, the strip can be separated from the form easily and/or quickly and/or preferably by hand. The strip can then be arranged in simple manner on and/or round and/or against a body part of the person whose data have been entered on the form. In this way it can be clearly visible that the person in question has filled in the form. Those persons who have not yet filled in the form can hereby be asked quickly and/or efficiently to nevertheless do so, without those who have already completed the form unnecessarily being asked to do so. It can moreover be determined in efficient and/or simple manner whether all persons present at a disaster have filled in the form, so reducing the chance of persons present not filling in the form.

[0007] After arranging of the strip it can moreover be clearly visible, for instance when persons present at a disaster are examined for possible injuries when filling in the form, whether such a medical examination has already taken place in the case of a determined person. This reduces the chance of persons with injuries not being treated, or not being treated quickly enough.

[0008] An advantage of the preprinted images and/or identifiers is that, after arranging of the strip on and/or round and/or against a body part of a person, a link can always be made to this person and his or her form, even when it is later no longer possible to communicate with the person in question. Because the images and/or identifiers are preprinted, the link between the strip and the form is already present before completion of the form. The chance of an incorrect link between the form and the strip, and therefore in fact the absence of a link between the form and the strip, is hereby reduced compared to a form with strip where the link is only established when the form is completed. This is particularly advantageous during disasters, since errors are more likely to be made due to time pressure and/or panic. Preprinted images and/or identifiers are also advantageous during disasters since they can be easily read by for instance an emergency worker without an auxiliary means being required for this purpose. The images and/or identifiers can for instance be unique. In this way the link between the strip arranged on, round or against a person and the form can always be made unambiguously and/or quickly and/or easily. This prevents the strip arranged on a person erroneously leading to an incorrect form or one strip leading to a plurality of forms. Furthermore, no data need be entered on the strip itself, which saves time and can further reduce the chance of for instance the above stated errors.

[0009] In a more specific embodiment of a form according to the invention the strip can comprise close to at least a first end zone connecting means which are adapted to connect the first end zone to the second end zone such that the strip can have a closed form after connection of the two end zones.

[0010] An advantage hereof is that using such connecting means the strip can be arranged easily and/or quickly as for instance a wrist or ankle band round respectively the wrist or ankle.

[0011] The connecting means can comprise an adhesive and/or hook and loop fastening and/or a snap connection.

[0012] These connecting means can be applied efficiently on the strip according to the invention.

[0013] The images and/or identifiers can comprise a code of at least numbers and/or letters.

[0014] Such a code of at least numbers and/or letters can be easily and/or clearly readable. When sufficient numbers and/or letters are used, it will moreover be possible to make sufficient combinations to realize a unique code.

[0015] In a subsequent, more specific embodiment of a form according to the invention the form and the strip can be manufactured from a writable plastic, for instance PP (polypropylene).

[0016] Such a writable plastic, in particular tyvek®, has the advantage that it can be written on with for instance a ballpoint pen. Such a plastic can moreover be resistant to water and/or other harmful influences, whereby the chance of damage to the form and/or the strip can decrease. This can be particularly advantageous in the case of disasters. A further advantage is that a strip of tyvek®, for instance as wrist or ankle band, can be worn comfortably and can cause less irritation.

[0017] In a subsequent, more specific embodiment of a form according to the invention the strip and the form can form a whole, wherein the strip can extend from an outer edge of the form.

[0018] It is advantageous for the form and the strip to form a whole, since the possibility of unintentional separation of the strip from the form can decrease.

[0019] A weakening line extending parallel to the strip, for instance a scored line or a perforation line, can extend between the strip and the form.

[0020] Such a weakening line has the advantage that the strip can be removed easily and/or quickly by hand from the form by tearing the strip from the form.

[0021] The invention will be further elucidated on the basis of embodiments shown in the drawing. In the drawing:

figure 1 is a top view of a form according to a first embodiment of the invention;

figure 2 is a top view of a form according to an exemplary application of the invention; and

figure 3 is a perspective view of a part of a wrist provided with a strip according to a further embodiment of the invention.

[0022] It is noted that the drawing is only a schematic representation of preferred embodiments of the invention. The drawing must not be deemed as being in any way limitative for the invention. The same or corresponding components are designated in the figures with corresponding reference numerals.

[0023] Figure 1 shows a form 1 with a strip 2 connected separably thereto. A two-dimensional bar code 3A and a number code 4A are arranged on form 1, these codes corresponding to respectively bar code 3B and number code 4B on strip 2. Codes 3A,3B,4A,4B are preprinted on form 1 and strip 2 such that a link can be established between the two after separation of form 1 and strip 2. Form 1 has a part 5 which can be written on with a ballpoint pen and on which personal data can for instance be entered.

[0024] As shown in figure 1, form 1 and strip 2 form a whole. Strip 2 can be separated from form 1 by manually tearing strip 2 off form 1 by means of perforation line 6. Perforation line 6 extends parallel to strip 2 and in this embodiment corresponds with an outer edge of form 1. When strip 2 of form 1 is in the situation where it is separated from form 1, strip 2 can be arranged round for instance a wrist of a person (see figure 3). This takes place by arranging strip 2 round the wrist and mutually connecting the two end zones I and II of strip 2. For this purpose strip 2 is provided close to a first end zone I with an adhesive strip 7, using which the second end zone II can be adhered to first end zone I. The two end zones I and II can overlap each other to greater or lesser extent, depending on the thickness of the wrist. Strip 2 can hereby be arranged in simple manner around wrists of both children and adults.

[0025] Figure 2 shows a preprinted form 1 according to an exemplary embodiment of the invention. Such a form 1 can for instance be distributed in the case of disasters. Entry fields 8 are present on the form in which persons involved in a disaster can fill in their personal data. As described above, form 1 comprises a strip 2 which can be separated from form 1 by means of perforation line 6. Both form 1 and strip 2 have the same respective preprinted number code 4A,4B. Each number code is used only once for a combination of a form 1 with strip 2, such that each separated strip 2 is linked to only one completed form 1. The whole of form 1 and strip 2 has so-called "A4" size. Both form 1 and strip 2 can be manufactured from tyvek®. They can thereby be written on with a ballpoint pen and can withstand damaging influences such as water.

[0026] Figure 3 shows a part of a wrist 9 around which is arranged a strip 2 provided with a one-dimensional bar code 10. As shown in figure 3, strip 2 extends as a wristband round the wrist.

[0027] It is noted that the invention is not limited to the above discussed exemplary embodiments. Instead of a strip which can be separated from the form by means of a perforation line, a strip can also be arranged on the form using an adhesive or the like.

[0028] Such variants and others will be apparent to the skilled person and are deemed to lie within the scope of the invention as stated in the following claims.

Claims

1. Form, wherein a strip is added to the form which is separably connected to the form and which is adapted to be arranged on and/or round a body part of a person;
characterized in that
the form and the strip each comprise a preprinted image and/or identifier, these images and/or identifiers being identical to each other or having an unambiguous relation with each other.

2. Form as claimed in claim 1, wherein the strip comprises close to at least a first end zone connecting means which are adapted to connect the first end zone to the second end zone such that the strip has a closed form after connection of the two end zones.

3. Form as claimed in claim 2, wherein the connecting means comprise an adhesive and/or hook and loop fastening and/or a snap connection.

4. Form as claimed in any of the foregoing claims,
wherein the images and/or identifiers comprise a code of at least numbers and/or letters.

5. Form as claimed in any of the foregoing claims,
wherein the form and the strip are manufactured from a writable plastic, for instance PP (polypropylene).

6. Form as claimed in any of the foregoing claims,
wherein the strip and the form form a whole, and wherein the strip extends from an outer edge of the form.

7. Form as claimed in claim 6, wherein a weakening line extending parallel to the strip, for instance a scored line or a perforation line, extends between the strip and the form.

Drawing