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EXAMPLE Incident Report
General Incident Information - Step 1
Please note fields with an * are compulsory
Severity rating*   Please select both Actual and Potential Severity for the Incident.Use the incident severity scale to rate the severity of the incident. Record both the actual and potential severity ratings for the incident. If near miss, 0 may be used in actual rating and your estimate of the potential rate should also be entered. Use the descriptors to assist with your best approximation of the two ratings.
(see severity scale)		 Actual    Potential
Region*  Record the region in which the incident occurred
Location of Incident*  The general area eg Tongariro National Park, Whanganui River, Hanmer Springs
(Name of: river, track, rock climb, etc.)
Grid Reference
(1:50,000) 6-8 digits
Date of incident*
 Click to Pick up the date  dd-mm-yyyy
Time incident* 
To the nearest hour in 24hr format eg. 21 for 9:00pm 		:00  hh:00
Incident Type*  You may select more than one category

Hold down 'ctrl' to select multiple types
Weather at the time of the Incident*  Tick the appropriate box which best reflects the weather conditions.
Fine Wet
Hot Cold
Calm Windy
Communications used
Lost day case*  Did this incident cause any activity days to be lost. Enter 0 for none.
Occurs if a participant or staff missed one or more days of activity beginning with the day following the incident
Number of Persons Involved*  Record only the number of people directly affected by the incident, eg tramping with ten people, with two people injured by rock fall. Number of people involved: two.
Number of people directly affected by this incident. Ie. Hurt or lost
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