RCC Incident / Near Miss Form
Data Processing Notice; Richmond Canoe Club takes your privacy seriously. We will only use your personal data to administer the incident report. All data you input here is also sent securely to relevant third parties only for the purpose of investigating the incident. We will only retain your personal data for as long as it takes for the incident to be resolved. At this point it will be deleted. External authorities may retain it longer for legal purposes.
Email address *
Near miss or incident?
First Name
Last Name
What is your email?
What is your phone number?
Are you a member of Richmond Canoe Club?
Clear selection
What was your role or connection with the incident?
When did this incident / near miss happen?
MM
/
DD
/
YYYY
Where was the incident / near miss
Incident Type - Please choose the most relevant description
If 'Other' incident type
Did the incident require medical treatment - Please choose all that apply *
If 'Other' medical treatment
Who was involved? (Names if possible)
Please describe the near miss or incident. Include here any relevant conditions such as weather, temperature, grade of white water, sea/river conditions etc.
What was the final outcome of the incident or near miss? (If known)
What can be learnt from this incident?
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Richmond Canoe Club. Report Abuse