Accident/ Incident Report Form

THE ALPINE CLUB OF CANADA
LE CLUB ALPIN DU CANADA
Canada’s National Mountain Organization – Founded in 1906
www.alpineclubofcanada.ca
L’organisation nationale de montagne au Canada – Fondée en 1906
www.clubalpinducanada.ca
Accident/ Incident Report Form
Please use this form to report accidents/incidents that happen on all section-sponsored activities and
have the Section Chair forward it to the ACC’s Executive Director at National Office. Please provide as
much detail as possible about the accident, the conditions at the time and the actions taken by the
group or outside rescuers. Pictures of the accident site and the exact location of the accident site are
immensely useful for the reviewers.
Date of report:
Date of Incident:
Report completed by:
Time of Day:
e-mail:
Address:
Phone #:
Participants:
Trip Leader:
Rope Leader:
Location of Incident:
(description and exact
map reference)
Incident Description:
(use back of form
for more details)
Other Witnesses:
Equipment Involved:
Weather Conditions:
(Snow pack, Ice, loose
rock, visibility, temperature etc.)
Other Significant Contributing Factors:
Person Injured
Name:
Phone #:
Address:
Treatment administered:
Rescue Description:
Canada's Mountaineering Community
La communauté canadienne des amateurs de montagne