Incident Report

The following report must be completed at the earliest opportunity following any incident which occurs during an FLCC activity. Incidents can be anything from a first aid incident to a serious injury, capsizing, paddling accident, violence, theft, or a heated discussion with a non-club member. An incident can also be a potentially hazardous situation, (for example, if equipment is left in a dangerous condition or position). The report may be completed by any member of FLCC.
Date of report *
MM
/
DD
/
YYYY
Reported by *
Phone number *
Email address *
Details of incident or concern
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident
Time
:
Location of incident *
Description of incident. Write a thorough and detailed description. *
If injury, detailed description of injury *
Person(s) involved in incident and/or witness(es)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy