WAC Incident / Near Miss Form
Tell us what happened so the club can learn from it! Names will be removed before this information is shared.
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?
Submit
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