2025 - General Incident Report

General Incident Report

RSG Arenas at Bridgewater - 1425 Frontier Road, Bridgewater, NJ 08807 - To report an incident, please provide the following information:
Date and time incident was reported:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Date and time when incident actually occurred:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Who was the main person involved in the incident/injured?*

First NameLast Name
Age*
Gender*

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Was there anyone else involved in the incident/injured?*
If yes, you will need to fill out a separate form for each injured person.
Who else was involved/injured? Add their Name, Age, & Phone Number*
Please provide Incident details*
Did the incident occur on the ice?*
Incident Location (if the incident took place on the rink, please indicate where it occurred by drawing an "X" below.*
Type of ice cut*
Ice Resurface Time*

Hour Minutes

AM/PM Option
Type of skate used:*
Medical Section
Was First Aid Or Any Medical Supplies Provided?*
Who Administered The First Aid or Provided Medical Supplies?*
Helper Name #1 - OPTIONAL

First NameLast Name
Helper Phone Number #1 - OPTIONAL
Please enter a valid phone number.Format: (000) 000-0000.
Helper Name #2 - OPTIONAL

First NameLast Name
Helper Phone Number #2 - OPTIONAL
Please enter a valid phone number.Format: (000) 000-0000.
Type of First Aid Administered, Including Medical Supplies Provided:*
If you don't know, say "Don't Know".
Why wasn't any First Aid or Medical Support Proviided:*
If you don't know, say "Don't Know". Did person "decline'? Or "no supplies available"
Was the injured person taken to the hospital?*
To what hospital?*
If the injured refuses medical attention and/or 911, please have them or a legal guardian sign below.
Do you wish to add a picture?

Cancelof
RSG Waiver Information (mark all that apply)*

Yes, the Release of Liability/Waiver was signed at the front desk.Yes, the individual has a waiver on file in DASH.Yes, the individual was wearing a waiver wristband.No to all the above.
List details from any witness & include contact details.*
Were the police notified?*
Did the Police give you a case or report number?*
Enter the Police Case or Report Number*
Was a report of this incident you just filled out given to anyone else? If yes, who?*
Person is who reporting this incident?*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Further General Comments*
Should be Empty:

General Incident Report

Medical Section