Incident Report

Incident Location

Injured Person's name

Home Address

Date of Birth

Gender

Occupation

WAWA Number

Event name

Specific location

Date of injury

Time of injury

Activity in which the person was engaged at the time of injury

Nature of injury e.g. fracture, burn, sprain, foreign body in eye including body location

Treatment provided by First Aid Officer

Off site treatment required

Ambulance called

Doctor/Medical Centre attended

Name of Chief Judge

Name of Boat Driver

Name of Safety Officer

Name of Event Judge

Signature of Chief Judge

Date