West Tyrone Ramblers
Incident Report Form
Please complete this form for all incidents, whether deemed minor, serious, a near miss, or if outside assistance was or was not required. The information supplied here is confidential and will assist the WTR Committee to develop an overview of incidents and help us provide relevant guidance and training.
This form should be completed by the person responsible for leading the walk. It should then be given to a member of the Committee to sign, and a copy kept on file. Please aim to return it within 10 days of the incident occurring. See accompanying notes for further information on how to fill in this form. Please fill in the form electronically or use black ink and write clearly.
|Date of Walk
|No of Participants
Person/Leader responsible for the Walk
Details of person affected/involved.
|DOB or approximate age
|(If applicable) details of the injury, the treatment received and current condition, (if known)
Details of incident (Please give as much detail as possible)
|Location, Date and Time / What happened and what action was taken?
Witness Name, Address, & Contact number
Any additional information or comments
Please email the completed form to firstname.lastname@example.org
How to complete the Incident Report Form
When to fill in the form
This is a generic incident report form for all West Tyrone Ramblers activities but is designed primarily for walks outlined in the WTR programme.
Please fill in the form as quickly as possible after the incident and return it as soon as possible, and within 10 days maximum. Members may choose to fill in the form electronically and email it to email@example.com If you return it electronically there is no need to send a hard copy in the post. The form is also available on the website, (see link provided above).
Please provide as much information as possible and use a continuation sheet if necessary. We request that contact details of at least one key witness are provided in case further investigation should be required. You may decide that due to the nature of the incident it is best to provide the details of a number of witnesses.
If an incident of a serious nature has taken place, please report it to the Chairperson at the earliest opportunity on 07584 412650. A serious incident is defined as posing ‘immediate danger to life where outside help is required to resolve the incident’.
This includes incidents where 999 has been called, urgent medical help is required, urgent help is required to get the party/member to safety, evacuation of party/member by emergency services.
What happens next?
Once your form is received by the Committee it will be reviewed immediately. An acknowledgement will be sent, and appropriate support made available. Occasionally further investigation may follow, in which case a member of the Committee will be in touch.