HFSC Incident Report Form

HFSC Incident Report
Skater

First NameLast Name
Reporter

First NameLast Name
Bystander(s)
Location
Date of incident
Describe the incident with as much detail as possible.
Was first aid treatment administered? If so, by who?
Was a family member/emergency contact notified? If so, who?
Transport Needed
Reporter's Signature
Date of Signature

MonthDayYear
Date
Should be Empty: