502 Dragons Incident Report

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Please complete as much information as you can as soon as possible after the incident. All incident reports should be completed within 24 hours of the incident; sooner is better! Thank you!

This form is documenting: *

an injury

first aid

incident

close call

observation

damage to equipment or facilities

Other:

Name of person completing form *

Best phone number for person completing form *

Any other parties or witnesses we should speak to? Please provide names and contact methods if possible.

Date incident occurred: *

YYYY

Time incident occurred: *

Time

What happened? Describe what happened/sequence of events. *

How was the situation resolved? *

Was the event, damage, or injury caused by an unsafe act (activity or movement) or an unsafe condition (equipment or weather)? Please explain.

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