From:  ___________________________



(note: This form is not to be used for minor scrapes, cuts or abrasions requiring a simple bandage or two. It is only for more severe injuries requiring immediate medical attention.)
HIKE LEADERS: Start gathering this information at the accident/injury scene if possible. Fill out this form ASAP. Email the completed forms to and keep originals in the club notebook under the “Accident/Injury Forms” tab.

(1)   Hike leader’s name.
(2) Name of the injured person.
(3) Names of at least three witnesses to the accident/injury.
Please include a copy of the Trip Release Form.
(4) Date and time of the accident/injury.
(5) Location of the accident/injury—trail name and GPS coordinates if available.
If you have a GPS track with the location marked, please include it.
(6) Nature of the accident or injury (fractures, cuts, puncture wounds, etc.).
(7) What was done to help the injury victim?
(8) Was medical evacuation necessary?
(9) If so, where was the injury victim evacuated to?
(10) Take several pictures of the accident/injury scene and the specific treatment area,
without showing the injury victim’s face if possible.

updated January 15, 2020

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