Three Rivers Incident Report Form
SCOPE: To ensure a safe community boating facility, all occurrences of injury (major or minor),
collision, flipping, etc must be reported using this form. See details below. Thank you.
Your Email Address: *
Your Name: *
Your Phone Number: *
Your Program/Affiliation: *
PROCEDURE
1. This Incident Report Form (IRF) is to report:
a. Any person overboard
b. Swamping or flipping, including singles
c. Any personal injury, no matter how small or insignificant.
d. A collision
e. Any other instance of unsafe conduct.

2. The person responsible for filing this IRF is:
a. The coach or Crew Leader in charge at the time of the incident.
b. The person involved in the incident if no Coach or Crew Leader was required.
c. Any person who observes a breach of the TRRA Rules and Regulations.

3. IRF’s must be filed using this form within 24 hours of the incident. This competed form will go to the TRRA Safety Committee and the TRRA Executive Director.
a. Failure to submit within 24 hours may result in immediate suspension of membership or privileges at TRRA.
DIRECTIONS
1. Complete this IRF in its entirety with as much detailed information as possible within 24 hours of the occurrence
of the incident.

2. Follow up with the TRRA Executive Director and Safety Committee as necessary.
Date of Incident: *
MM
/
DD
/
YYYY
Time of Incident: *
Time
:
Were there any injuries? *
Was any equipment damaged? If TRRA equipment was damaged please fill out separate damage report form. *
Check the appropriate box. If incident is not listed, write-in. *
Required
Describe the Incident in Detail: *
Number of Persons Involved: *
Number of Persons Requiring Treatment: *
Air temperature at the time of incident: (https://w1.weather.gov/data/obhistory/KAGC.html) *
Wind speed and direction at the time of incident: (https://w1.weather.gov/data/obhistory/KAGC.html) *
General description of conditions: *
Any other additional information:
Please send photos and images, if necessary, to safety@threeriversrowing.org
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