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