Incident Detail - Outing

Outing Name

Outing Program

Local NationalICOOther

Outing Type

Was this a day trip/Overnight?

Day TripOvernight

Did this incident occur in frontcountry or backcountry?

FrontcountryBackcountry

Chapter or Subcommittee

This should be the name of the primary Sierra Club program, chapter, or group that is responsible for managing the activity. Examples: Sierra Student Coalition, Military Outdoors, Latino Conservation Week - Our Wild America Organizing, Angeles Local Outings - Wilderness Training Course.

Date of the Incident

Time of the Incident

Incident Location

This is the trail, wilderness, park, or general location

City

State

Zip Code

Country

Position of the Person Reporting the Incident

If other, please specify

Email of the person reporting the incident

Name, Address and Phone of the Person Reporting the Incident

Incident Report Details

Incident Type

Other

Injury/Illness

Other

Primary Contributing Factor

If Other, Please specify

Primary Weather Condition

Any Additional Information on Weather Condition?

First Aid Provided

Who Provided First Aid/Medication

What type of first aid was provided?

Did this Incident involve an evacuation?

If Yes:

One Sentence Summary of the Incident

Incident Narrative

Lessons Learned

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

Affected Person Details

Affected Person: Name, address, email and Phone number

Age of the Affected Person

Gender

Height

Weight

Has the Family been Contacted

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

Attachments

Contact Information