Sierra Club Incident Report Instructions

Sierra Club expects incidents to occur throughout your program and operations. The Club expects all staff and volunteers to promptly report incidents in order for us all to learn and to continue to build a culture of safety.

An Incident Report will be completed for any occurrence that threatens or causes personal or organizational loss including physical, emotional or property damage.

Sierra Club also encourages the reporting of Near Misses where there was no loss or damage, but given a slight shift in time or position, damage or injury could have occurred.

Life-threatening incidents/emergencies/fatalities that require rescue or evacuation should be reported immediately by telephone to 1-888-OUTINGS (888-688-4647) or 001-303-281-9914 if calling internationally

Please send any additional documentation or photographs to

program.safety@sierraclub.org

Incident Detail

Date of the Incident

Time of the Incident

Incident Location

City

State

Zip Code

Country

Name, Phone of the Person Reporting the Incident

Email Address of the Person Reporting the Incident

Position of the Person Reporting the Incident

If other, please specify

Has the Family been Contacted

Who contacted the family? Please enter the name, email address, phone number

First Aid Provided

Who Provided First Aid/Medication

Event Details

Event Name

Entity Name

Event Type

Primary Weather Condition

Any Additional Information on Weather Condition?

Incident Report Details

Incident Type

Other

Injury/Illness

Other

Activity Type

Other

Primary Contributing Factor

If Other, Please specify

Other Contributing Factors

Did this Incident involve an evacuation?

If Yes:

Affected Person: Name, address, email and Phone number

Age of the Affected Person

Gender

Height

Weight

Were more people affected?

Yes

Affected Person 2: Name, address, email and Phone number

Affected Person 2: Age

Affected Person 2: Gender

Affected Person 2: Height

Affected Person 2: Weight

If more people were affected? (3 or more): Please enter their Name, address, email and Phone number

One Sentence Summary of the Incident

Incident Narrative

Lessons Learned

Other Information

Name, Email, Phone and Address and Role of Organizations and Other People Involved

Attachment: Waiver, Medical Form, Photograph, etc

Contact Information