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EXAMPLE Incident - Ski Field Report
Please note fields with an * are compulsory
Region
------ North Island ------
Northland
Auckland
Coromandel
Waikato
Rotorua
Bay of Plenty
East Coast
Taranaki
Ruapehu
Lake Taupo
Hawke's Bay
Manawatu / Wanganui
Wellington
Wairarapa
------ South Island ------
Nelson
Marlborough
West Coast
Canterbury
Dunedin
Wanaka
Queenstown
Central Otago
Fiordland
Southland
------ Other ------
Date of incident*
dd-mm-yyyy
Time incident
To the nearest hour in 24hr format eg. 21 for 9:00pm
: 00
hh:00
Age*
Gender*
m
f
Ethnicity
-------------
European/Pakeha
New Zealand Maori
Pacific Island
Asian
Other
Unknown
Accident Location*
Set locations
here
--- Unknown ---
Activity*
-------------
Skier
Snowboarder
Tubing
By Stander
Other
Transport*
-------------
Helicopter
Rig
Skidoo
Vehicle
Walk-in
Walk-in with Patrol
Other
Injury Event Code*
click here for list
eg. 870; 920
Snow Conditions*
-------------
Soft
Hard
Ice
Spring
N/A
Cause of Accident or Collision with*
-------------
Fell
Fell after jump
Lift Accident
Collision with Skier
Collision with Snowboarder
Collision with natural object
Collision with manmade object
Other
Ability
N/A
Learner
Intermediate
Advanced
Expert
Safety Equipment worn*
---------------------
None
Helmet
Wrist guards
Helmet & Wrist guards
N/A
Mountain Rental Property
No
Yes
Area Staff
No
Yes
Work Injury
No
Yes
Other Notes
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