Incident Report

Please submit the incident report as soon as possible, no later than 48 hours after the incident. All reports submitted through this form will be directed to the safety officer and directors for review and follow-up. Your information will be handled confidentially, and we will only contact you if further details are required.

Reporting Individual

First Name *

Last Name *

Email *

Incident

Type of incident *
Capsize (huli)CollisionInjuryEquipment FailureMedical EmergencyNear MissPersonal ConflictTheft

Date of incident *

Time of incident *

Location of incident*

Who was involved?

Were there injuries? Describe who, and what injuries and treatment, if any.

Equipment involved? Describe damage, if any.

Describe the incident. Include the sequence of events and results of the incident

Do you have any relevant photos, videos, or documents related to the incident.
photosvideosdocuments

Recommendations and followup actions

— I Ka lōkahi o Ka hoe wa’a —

In the Unity of Paddlers

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