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HYC Incident Report Form
Please fill out and submit this form to report incidents to the club management.
15
Questions
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1
What are you reporting?
Injury/Medical incident
Damage to HYC property
Damage/theft of PERSONAL property
Other incident that occured at HYC or during HYC activities
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2
Name
Person making this report
First Name
Last Name
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3
Email
example@example.com
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4
Phone Number
Please enter a valid phone number.
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5
Preferred method of contact
Should we need to contact you, how would you like us to get in touch.
Phone
Email
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6
Date of occurance
If you don't know when it happened, input the date you became aware of what you are reporting
-
Date
Year
Month
Day
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7
Time of occurance
If you don't know when it happened, enter the time at which you became aware of what you are reporting
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Minutes
AM
PM
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PM
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8
Location of incident
For example: In the clubhouse, on Q dock, in the workshop
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9
Did this happen to you?
YES
NO
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10
Who did this happen to?
First Name
Last Name
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11
Were there any witnesses or any other HYC members involved?
YES
NO
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12
Names of witnesses or other members involved
Please provide first & last names of any key people
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13
First aid or Emergency Services
Check all that apply
First aid
911 was called
Ambulance
Police
Fire
Police report filed
NONE
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14
Description
Please ensure to include all important details.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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15
Upload any photos or documents
(optional)
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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