Accident Report
Complete this form if a volunteer or a patron suffers a mishap at any Bexar County Master Gardener event.
Name of Program/Event:
*
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Event Chairperson:
*
Name of Injured Person(s) and Phone Number(s):
*
Detailed Description of Accident
*
Name(s) and Phone Number(s) of Witness(es):
*
Was EMS or other health professional called?
Yes
No
Who was contacted?
Was the injured person transported to the hospital?
Yes
No
Which hospital?
Other pertinent information
*
Reported by:
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Report
Should be Empty: