INCIDENT REPORT FORM
Name
First Name
Last Name
Email
example@example.com
Please write down the Location, date and time the incident occurred.
Who was involved? Were they all club members?
Did the person(s) involved visit hospital or were any emergency services called?
YES
NO
Description of incident: What happened, how it happened. Include any details that may have contributed to the incident (i.e. weather conditions, equipment failure). Be as specific as possible- use additional paper as necessary and attach to form.
Actions taken (including first aid performed, emergency response, all third parties involved and/or informed etc.):
Submit
Should be Empty: