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Incident Report

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  2. Town of Castle Rock: Parks & Recreation Incident Report

    First Report of Incident. After submitting this form, staff are to print off and sign completed report and turn in hard copy to your supervisor.

  3. Was an injury reported?*

  4. Was Police Notified?*

  5. Was EMS Notified?*

  6. Emergency Contact Notified*

  7. Injured/Affected Party

    This section is information identifying the injured/affected party.

  8. Gender*

  9. xxx-xxx-xxxx

  10. Emergency Contact

    This section is information identifying the emergency contact of the injured/affected party.

  11. Relationship to injured/affected party

  12. Side of Body Injured

  13. Part of Body Injured

  14. Code

  15. Care Provided

  16. Include any facts related to this incident and details of care provided. The system will not allow inappropriate language to be submitted. Please abbreviate where appropriate.

  17. Incident Location

    Check all boxes that describe the area in which the incident took place.

  18. Program Type*

  19. Where did the incident take place?*

  20. School Facilities

  21. Locker Room/Restroom

  22. Athletic Venue

  23. Aquatic Space

  24. Fitness Areas

  25. Event Venues

  26. Rooms/Offices

  27. Activity Areas

  28. Witness Information

    Please include information from witnesses of the incident.

  29. xxx-xxx-xxxx

  30. xxx-xxx-xxxx

  31. Staff Completing this Form

  32. xxx-xxx-xxxx

  33. Hard Copy Signature/Date

    ___________________________________________

  34. Supervisor

  35. Supervisor Signature/Date

    ___________________________________________

  36. Leave This Blank:

  37. This field is not part of the form submission.