Outdoor Education Incident Report Page 2
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1
2Activity Duration*
Number of people involved*
Was this an EOTC incident?
YES
NO
_____ Participants e.g. students
_
Curriculum area (schools only)
______ Volunteer helpers e.g. parent help
______ Hours
¨
English
¨
Technology
¨
Languages
¨
Social Sciences
______ Qualified instructors
e.g. 3 1/2 days = 84 hours
¨
Mathematics
¨
Arts
______ Supervisors e.g. teachers, youth leaders
¨
Science
¨
Health & PE
4. Activity Leader
(Choose leader most in charge of the group that had the incident)
Was there a leader*?
YES
NO
UNKNOWN
(If no, or unknown, go to 5.)
First name:
Last name:
Does the activity leader have relevant activity qualifications*?
YES
NO
UNKNOWN
Age*: ______
Gender*:
M
F
Leader’s experience
level*:
1
2
3
4
5
6
UNKNOWN
UNKNOWN
UNKNOWN
(1= Inexperienced,- 6 = Highly experienced)
5. Equipment involved in incident
Vehicles, property, gear, equipment damaged, equipment lost, etc.
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6. Narrative
(general description of incident - what, where, how)
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7. Causal Factors
Equipment*
Environment*
People*
Activity Leader/s
Participant/s
¨
No equipment
¨
Adverse weather
¨
Inadequate physical condition
¨
Inadequate physical condition
¨
Wrong equipment
¨
Inadequate visibility/dark
¨
Inadequate mental condition
¨
Inadequate mental condition
¨
Faulty equipment
¨
Terrain
¨
Inadequate emotional condition
¨
Inadequate emotional condition
¨
Inadequate design
¨
Water
¨
Inadequate health – hygiene or
¨
Inadequate health – hygiene or
¨
Other __________
¨
Animal/insect/plant
medical
medical
¨
n/a
¨
Other __________
¨
Pre-existing condition
¨
Pre-existing condition
¨
n/a
¨
Judgement error
¨
Judgement error
¨
Inadequate supervision
¨
Inadequate supervision
¨
Inadequate training/experience
¨
Inadequate training/experience
¨
Failure to follow policies
¨
Failure to follow policies
¨
Improper motivation
¨
Improper motivation
¨
Other __________
¨
Other __________
¨
n/a
¨
n/a
Explain in detail what you think caused the incident. Include any suggestions, observations or recommendations regarding the incident.
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Hand form into your organisation’s administrator for input to the National Incident Database – Thank you.
For further copies go to
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