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EXAMPLE Incident - Ski Field Report
**** Please fill out the required information
Date of incident*
dd-mm-yyyy
Time of 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
Incident location*
Use 'Edit Locations' in the left menu to set.
-------- Please Select --------
Mt Hutt
-------- Please Select --------
South Face
Activity*
------------------------------
Skier
Snowboarder
Tubing
By Stander
Other
Transport*
------------------------------
Helicopter
Rig
Skidoo
Vehicle
Walk-in
Walk-in with Patrol
Other
Severity code*
------------------------------
A: Life threatening /fatal
B: Serious
C: Significant
D: Moderate
E: Minor
Injury code*
Snow Conditions*
------------------------------
Soft
Hard
Ice
Spring
N/A
Visibility
Clear
Scattered
Broken
Overcast
Obscured
Unknown
Cause of Incident or collision*
------------------------------
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*
------------------------------
None
Helmet
Wrist guards
Helmet & Wrist guards
N/A
Rental equipment
No
Yes
Area Staff
No
Yes
Work Injury
No
Yes
Other Notes
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