Sammamish Rowing Association Injury Incident Report

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Use this form to report accidents that take place at SRA. If equipment is damaged, please fill out the boat damage report form.

Email *

Report prepared by *

Date of incident *

YYYY

Time of Incident *

Time

Relevant weather at time of incident (air temp, water temp, wind speed) *

Name of Affected Athlete *

Location of Incident *

What happened? *

Water immersion/flip

Fall

Head Injury

Collision

Major crab

Medical Emergency - asthma, seizure, heart attack, etc

Other:

Required

What was the injured person doing at the time of the incident? *

Fully describe the Incident - any and all details *

What part of the body was injured? *

were emergency personnel called? *

were parents/guardian of a minor called? *

Were boathouse regulations being followed at the time of the incident? *

What follow up actions were taken? *

A copy of your responses will be emailed to the address you provided.

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