Accident/ Incident Report Form
Transcription
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