Strathclyde Park Rowing Club - Incident Report Form

Please complete this form to report any accident, collision or capsize, especially those involving injury to persons or damage to equipment.

Details of the person reporting and the incident (* = required)

Name *

Position or Role *

Address *

Evening Phone Number *

Email *

Who was involved? (Individuals, clubs, third parties)*

Date of Incident (DD)

(MM)

(YYYY)

Time (24hr) * (hh)

(mm)

Where did the incident occur? *

Description of the circumstances of the incident - eg training outing, name of regatta or head race *

Please give a full description of the incident. This should include weather and water conditions. *

Please attach any additional details - eg scanned drawings/diagrams or photographs - if these will enhance the description (jpeg format - max 30 megabytes). Alternatively, you can pass on drawings or photos to a committee member.

List any injuries sustained, by whom, who treated them and where. Also list any damage sustained by boat(s) or to property. *

Add any further comments or additional information you think could be useful - eg list of witnesses with addresses, etc.

What further actions have been or will be implemented to avoid repetition of the incident?

By ticking the box below I confirm that the facts above are correct.

Confirmation

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