River Ambassador Incident Report

River Ambassador Incident Report

In an emergency call 911 FIRST, and then submit this report.
Date of Incident:

MonthDayYear
Incident Time:
What type of incident was this?

Medical Emergency on LandMedical Emergency on WaterFireCrime/VandalismOther
Location:

Milo McIver State Park: Lake LaunchMilo McIver State Park: Upper LaunchMilo McIver State Park: Lower LaunchBarton ParkCarver ParkOther
Name of Person Reporting:
Phone Number of Person Reporting:

Area CodePhone Number
Describe the facts of the incident and your response. Please include all information that may be relevant. Be thorough and objective.
Your signature, confirming the above information is true to the best of your knowledge.*
Today’s Date:*

MonthDayYear
A copy of this form will be sent to Volunteer Coordinator Nicole Fredericks and relevant park staff. Please note that they may follow up with you to confirm your safety and to review incident details.
Should be Empty: