Title Page
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Conducted on
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Prepared by
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Location
Subject Information
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Date and approximate time of incident
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Subject's Name
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Subject's Date of Birth
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Is Subject under the age of 18?
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Guardians name
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Guardians relationship to guest
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Guardians phone
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Guardians Address
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Subject's role in the park
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Subject's phone number
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Subject's address
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Voluntary witness information
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Witness relationship to subject
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Subject's reported injury/complaint
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Subject's description of events
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Location of incident
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Any visable sign of injury?
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If yes, briefly describe what was visable
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Was 911 Called?
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If yes, did they take the ambulance or were they treated at the park?
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Was the subject offered an ambulance?
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Was the offer accepted or denied by subject?
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What Medical Facility was the subject transported too?
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What was the subjects reason for denial?
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Reason for not offering an ambulance?
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Identify equipment worn by guest (harness # and equipment #)
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Did the guest complete the course?
Staff information
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Staff first responder
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Contact numbers for staff involved
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Description of events (as witnessed by staff)
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Actions taken by staff
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Photograph of area where incident occurred
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Supervisor
Accident/Incident Follow up
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Is this a first occurrence of this type of accident/incident at this location?
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What is this occurence?
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Has there been any preventative measures identified to prevent this from happening again?
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What are the measures identified?
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Manager who reviewed report
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Any Follow-up contact with guest?
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If yes, provide details and dates/times
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Has guest made any requests of Tree Trails following the incident?
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If yes, briefly describe requests