WAC Incident / Near Miss Form
Tell us what happened so the club can learn from it!  Names will be redacted before this information is shared.
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Email *
Your name (will not be shared outside the RMC) *
Your email address *
In case we have any follow-up questions
Was this an incident or near-miss? *
Location *
Name of outing *
Date of Incident / Near-Miss *
MM
/
DD
/
YYYY
Person(s) involved *
Activity *
Examples: rock climbing, skiing, cooking, hiking, belaying
Environmental conditions *
Examples:  muddy ground, snowing, low visibility, wet rock, glaring sun
Narrative *
In a few sentences, describe what happened.  Were any injuries sustained?
Contributing factors *
In a sentence or two, describe what factors you think contributed to this incident (or near-miss).  Examples: fatigue, weather, inadequate training, poor site selection, time pressure, distraction, poor self-care.
Anything to learn from this incident?
Is there anything we should do differently next time?
A copy of your responses will be emailed to the address you provided.
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