Report Form - Accident Register

Please note - although names may be asked for in this form they will not be used in the final report, they are for verification purposes only.

How to use this form

A submitable version of this form is under construction. In the meantime please cut and paste the list of questions (below) into a word processing document of your choice and send it in as an attachment. Once you've pasted the question list into your document just type in your answers on the line/s after each question. Email it to us at: administration

1/ Date of incident


2/ Timing of incident (start to finish)


3/ Location - be very specific, include route names, grid refs if possible


4/ Name of reporter


5/ Name of victims and/or participants. Please indicate the age and experience of each person in the activity being undertaken.


6/ Age of Victim

7/Years of experience in the activity being undertaken.

8/ Activity type (type "YES" after the relevant category)

Abseiling (dry / non canyon)

Canyoning (wet or dry / with or without abseils)

Rock Climbing

Other (please specify)


9/ Planned activity duration (start time and finish time)


10/ Injury type - be very specific if possible


11/ Was evacuation required? (type YES or NO)


12/ If YES - who carried out the evacuation? (detail rescue services, individuals or groups)


13/ Detailed description of the incident (in as many words as you require)


14/ Your comments on possible prevention of a similar incident in future, please include your thoughts on the lessons learned etc


15/ Weather conditions at the time of the accident.


16/ Other comments


17/ Contact details of the Rescue service/s that attended this incident, please include individual names if known


18/ Your contact details (for verification purposes only)

phone (day time)

phone (night time)

phone (mobile)

email address