Information
Managers Incident Report
-
Document No.
-
Location
-
Conducted on
-
Conducted by
- matthew
- mark
- luke
- john
-
STRICTLY PRIVATE & CONFIDENTIAL
-
Date/Time
-
Ice Rink
IP Personal Details
-
Name
-
Contact number
Incident Reporters Details
-
- Ian, 3 Ice Road, ice land 3
- Mary, ice road, ice land 4
Incident Details
-
Please give a brief account of the accident in mention as well as any injuries that have occurred as a result of this incident
-
What if any treatment was given given and by whom
-
What the IP advised to seek further medical attention?
-
Was the IP taken to hospital? If so how?
-
Import site plan from photos and annotate
Information log
-
Photo of Medics report - do not capture any confidential information.
-
Incident marked on the daily diary?
Skates / equipment.
-
Skate Number.
-
Was all equipment in use of a satisfactory condition? Skates sharp and structurally sound? Laces in tact? Blades in good condition?
-
Notes on any additional equipment.
Photos.
-
Picture of area where incident took place.
-
Picture of rink from position 1
-
Picture of rink from location 2
-
Picture of equipment / skates
-
Picture of equipment / skates 2
Declarations
-
I have completed this report to the best of my knowledge and all of the information I have submitted is correct.
-
Signed IP
-
Signed Medic
-
Signed Manager
-
Date/Time
