Incident Report
Incident Reporter Contact Details
Your Name
*
Enter the name of the incident reporter
Your Phone Number
*
Enter the phone number of the incident reporter
Your Email Address
*
Enter the email address of the incident reporter
Location of Incident
Sailing Venue
*
Please Select
Winstones Lake
Awatea Lake
At which of our sailing venues did the incident occur
General Location - Winstones
*
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1. Quarry gate
2. Quarry access road
3. Container
4. Jetty
5. West shoreline sailing area
6. East shoreline sailing area
7. Te Roto Road entrance
Select the general location of the incident
General Location - Awatea
*
Please Select
1. Car park
2. Jetty
3. Northwest sailing area
4. North sailing area
5. Footpath
Select the general location of the incident
Incident Details
Incident Type:
*
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Person harm
Loss or damage of plant or equipment
Environmental harm
Near miss
Incident Description
*
Give a description of the incident
Incident Response
*
Please Select
None required
First Aid administered
Water rescue performed
CPR performed
Fire doused
Emergency Services Called?
*
Please Select
None
Police
Fire
Ambulance
Winstones Aggregates Informed?
*
Please Select
Yes
No
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Recommended Action
Recommendations For Preventing a Reoccurrence
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