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Incident Form
This form is to be used in the event of accident, incident or near miss.
Incident *
Name of person affected - I.e. Casualty *
Your answer
Land & Wave Staff Involved *
Your answer
Other Witnesses Involved *
Your answer
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
Location of Incident *
Your answer
What activity? *
Your answer
What happened? (Include first aid given) *
Your answer
Did they go to hospital? *
Conditions - Sea State, Weather, Wind etc *
Your answer
Full name of person completing the form *
Your answer
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