Learn to Hunt Incident report
Chapter Information
Chapter Name
*
Chapter Number
*
Chapter Regional Representative
*
Contact Information
Contact Name
*
First Name
Last Name
Contact Phone
*
Format: (000) 000-0000.
Contact Email
*
example@example.com
Event Information
Event Name
*
Event Date
*
-
Month
-
Day
Year
Date
Event County
*
Event State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Description of Event Incident
Incident Summary
*
Please include who was in the field, their roles, and a detail description of the incident
Did the event adhere to PF & QF's Learn to Hunt Safety Guidelines?
*
Yes
No
Did all participants complete a hunter’s safety course with the state wildlife agency prior to the event?
*
Yes
No
Were liability waivers completed by everyone in the field (mentors, dog handlers, participants?)
*
Yes
No
Was the incident reported to local authorities?
*
Yes
No
If yes, which agency or agencies responded?
Responding Agency Officer Name
First Name
Last Name
Responding Agency Officer Phone
Format: (000) 000-0000.
Responding Agency Officer Email
example@example.com
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For Event Incident(s) Involving Injuries
For event incidents involving injuries, add up to 3 injured persons.
Add Injured Person #1?
Yes
No
Injured Person #1
Injured Person #1 Name
First Name
Last Name
Injured Person #1 Phone Number
Format: (000) 000-0000.
Injured Person #1 Email Address
example@example.com
Injured Person #1 Nature of Injury
Was Injured Person #1 treated on site or taken to the hospital?
Please Select
On site
Hospital
Section Collapse Break
Add Injured Person #2?
Yes
No
Injured Person #2
Injured Person #2 Name
First Name
Last Name
Injured Person #2 Phone Number
Format: (000) 000-0000.
Injured Person #2 Email Address
example@example.com
Injured Person #2 Nature of Injury
Was Injured Person #2 treated on site or taken to the hospital?
Please Select
On site
Hospital
Section Collapse Break
Add Injured Person #3?
Yes
No
Injured Person #3
Injured Person #3 Name
First Name
Last Name
Injured Person #3 Phone Number
Format: (000) 000-0000.
Injured Person #3 Email Address
example@example.com
Injured Person #3 Nature of Injury
Was Injured Person #3 treated on site or taken to the hospital?
Please Select
On site
Hospital
Section Collapse Break
Please verify that you are human
*
Submit
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