Badgerland Incident Report Form

Badgerland Incident Report Form

For reporting accidents, injuries, and property/vehicle damage.
Who Is Reporting This Incident?
What Is Your Name?

First NameLast Name
Your Email:
example@example.com
Your Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
What Are You Reporting (Check all that apply)?
Describe Your Relationship Or Role In Regards To The Incident:
(for example, "I was the event lead for this SU event" or "I was driving the vehicle")

Tell Us About The Location Of The Incident.
Name Of The Event:
(i.e. SU Camporee, Badgerland Day Camp, Troop Camp Out)
Where Did the Incident Occur (either name the property or provide a description of where it occurred):
(eg. Camp Brandenburg, the corner of Main and State in Janesville, WI, etc.)
Address Of The Event Location:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
This Event Was:

Other
Nature And Purpose Of The Activity:
What Date Did The Incident Occur?

MonthDayYear
Date
Time Of The Incident:

Hour Minutes

AM/PM Option
Exact Location Of The Incident:
For example, Kitchen at Hilltop near the kitchen island.
Describe What Happened.
List only the known facts of the incident/accident. Do not make assumptions. If someone stated that they saw or heard something, list that person's name and exact statement made. If anyone was injured, what were they doing at that time? Please describe the nature and exact location of any injuries. Do not diagnose injuries unless qualified to do so. State only where an injury is visible/known and what is observed/treated.

What Damage Was Done to Property?

You indicated that the incident included damage to a property or automobile. Please provide us with the additional information below.
Which Location Or Vehicle Are You Reporting Damage For?
Please provide location and building or unit name, if applicable.
Was A Police Report Filed?
If A Police Report Was Filed, Please Provide The Name Of The Officer(s) And Jurisdiction It Was Filed With.
For example, Officer Smith of Dane County Sherriff's Department.
Is The Property Or Vehicle Useable? Please Describe The State Of The Property/Vehicle.

Thank you for submitting information about your incident or accident. Badgerland staff will be in touch and provide information about the next steps in the process. If you have questions before they reach out, please call 800.236.2710 or email info@gsbadgerland.org.

Please push the Submit Button below to complete your form. You will be emailed a copy of your submission.
Should be Empty:

Who Is Reporting This Incident?