Sligo Walking Club – Incident Reporting Form
Injured Party/Parties
Name/s:______________________________________________________________
Membership No:________________________________________________________
Date of Birth:___________________________________________________________
Phone Number:_________________________________________________________
Email:________________________________________________________________
Walk Leader Details
Name:________________________________________________________________
Membership No:________________________________________________________
Phone Number:_________________________________________________________
Email:_________________________________________________________________
Incident Details
Location:_____________________________________________________________
Date:________________________________________________________________
Time:________________________________________________________________
Activity:______________________________________________________________
Incident Description (For additional space please turn over)
Learnings from this Incident (For additional space please turn over)
Leader Signature:__________________________________Date:__________________
Injured Parties Signature:_______________________________Date:_________________