HSWC Incident Report Form

This form should be completed by a Club member as soon as possible after an incident (accident, medical event, or property damage). When submitted, this information will be sent to the Club's Chair.

Walk Leader or Event Organiser:

INCIDENT

Location of incident e.g. desciption, What3Words, Grid ref:

Date of incident:

Time of incident:

What happened and what action was taken:

PERSON INJURED OR AFFECTED

Subject's name:

Address:

Additional information… e.g details of any injury, the treatment given and current condition (if known):

Injured or affected person is:Club memberTrial walkerGuest

Pictures if available

Drag and Drop (or) Choose Files

ADDITIONAL INFORMATION, FOR EXAMPLE FROM A WITNESS

Witness:

Address:

Witness comments:

PERSON COMPLETING THIS FORM

Completed by:

Contact Details:

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