MRT Incident Report
Use this form to report an incident involving MRT athletes or staff occurring during any MRT sanctioned activity or travel. Examples include, but are not limited to: athlete injuries, staff work related injuries, vehicle accidents, and behavioral incidents. If it happened "on our watch" and it is something that may require further explanation or follow-up with parents, staff, or our insurance carrier, then it should be reported on this form to insure timely and accurate information. This will ensure the best possible outcome for our athletes and the MRT community.
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Email *
Type of Incident *
Injured Person Last Name *
Injured Person First  Name *
Injured Person Address
Injured Person  Phone Number
Injured Person  Email
Injured Person  Info
Injured Person's Age
Injured Person's Date Of Birth
MM
/
DD
/
YYYY
Injured Person's Medical Insurance Info
Date of Occurrence *
MM
/
DD
/
YYYY
Time  of Occurrence *
Time
:
Where did the incident occur?( e.g. name of run , ski area, etc) *
Short Description of incident ( 5 words or less) *
Incident location *
Required
Weather Conditions *
Required
Surface *
Required
Mechanism Of Injury *
Required
In which kind of training did incident occur? *
Required
Description of Accident (please use FACTUAL DETAIL). *
Classification of Injury *
Required
Body part/s Injured ( e.g. right upper arm, left thigh, right lower leg, left knee, right elbow, torso, abdomen, etc) *
Primary Injury *
Required
Disposition *
Required
Please list any witnesses (include phone numbers of individuals, if on video please send to PD & HC)
Was Ski Patrol or Law Enforcement notified/involved?
Clear selection
If YES, please provide patroller's/officer's name and contact info.
Describe any medical attention provided at the scene and who administered it.
If this involved an athlete, have their parents been notified? *
Required
Please provide the names and contact info that will be used for follow-up (Ex: parent/hotel manager/van driver, names & numbers)
If this is an injury, describe the injured person's current status at the time of this report as you know it:
Who is filing this report (name, phone,) *
What follow through has been done so far with the people involved email/ phone call /letter sent?
Additional Notes or Comments?
NEXT STEPS***
1) Notify Head Coach or Program Director NOW via email/phone/or text that you have filed this report.
2) If the athlete's parents have not been notified at this time, please follow-up and ensure that they are informed.
3) If this injury should result in a training/race restriction, please note this under the JERSEY NUMBER section of the athletes' TeamSnap profile (section above "position").
4) An injury to a staff member will require a Worker's Comp report to be filed. See John Rust.
A copy of your responses will be emailed to the address you provided.
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