INCIDENT REPORT
Complete this form whenever an injured person needs first aid or attention from a medical professional, even if it is refused by the rider. Take as many photos as possible.
1. Tour Name.
2. Tour Leaders.
PLEASE SPECIFY WHICH GUIDE IS FILLING OUT FORM
3. Date and time of incident.
4. Name of injured person.
5. Location, be as specific as possible. Note approximate mileage on bike route.
6. Description of incident.
7. Please describe injuries. Be specific.
8. Did both leaders strongly recommend further medical assistance?
YES
NO
9. Did the injured person agree to seek further medical assistance? If no, give details in other.
YES
NO
Other
10. Signature of injured person accepting full responsibility for no further medical assistance.
11. Was first aid administered and by whom, be specific.
12. Name of ambulance, hospital/urgent care and time of arrival.
13. Police officer's name, phone number and time of arrival.
14. Initial here to indicate you asked for a copy of the police report to be sent to our office:
*
15. Were rental bicycles involved? If so which ones and what is their conditions.
Add photos below if bike is damaged
16. Upload photos:
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Bicycle damage
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17. Names of witnesses with contact info if not on tour.
18. Witness descriptions of incident.
19. Auto involved ? If yes add photo of license plate, registration, drivers license and insurance card below.
Yes
No
20. Upload photos:
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License plate, Registration, Drivers license, Insurance card
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21. Is there damage to the vehicle please describe.
Add photo below
22. Upload photos:
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Vehicle damage
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23. Comments: Use this section to keep a journal of the chronological sequence of events AFTER the incident occurred. This information is important and should be recorded accurately.
Use voice to text
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