INSTRUCTIONS ON FILLING OUT INCIDENT REPORT
(PRINT CLEARLY!!)
RULE:
Every
line, blank, check off box is either filled out or enter a N/A, with one and
only one exception, Incident #. (it is located at the top of the page and will be filled out
by management)
Top of form: Ski area: DSR and also put the date & time of the incident. Management will provide Incident # so leave it blank.
LOCATION
- Check the appropriate boxes and put N/A in the others that do not apply.
- If on a trail, use Area map to pinpoint location (ex: North Trail – near Lance’s leap)
- Check the appropriate Trail Rating!
- Check the Skied Trial before or Ridden before, IF applicable
- If pt. was in
- If lift was involved make sure the lift operator fills out lift op report.
INJURED PERSON:
- Each item needs to be filled in or checked off!
- Don’t forget to Check Male/Female and get DOB, Age, etc.
- Occupation – for minors you can put Student
- SSN: DON’T ASK FOR
IT… just put
N/R (Not required)
DESCRIBE INCIDENT IN
INJURED PERSON’S OWN WORDS:
- Notice the underline OWN words. Do not interpret or help Pt. and put quotes around exactly what Pt. said in both entries in this section.
WITNESS:
- Put a check mark if witness was involved in the incident.
- Either fill in info on both lines or have a N/A on any line that does not have info. If a witness is involved
have them fill out Witness report form, if they can be located. If on scene ask the witness to come to the
patrol room and fill out a report.
PROBABLE INJURY:
- Check appropriate box(es)
INJURY ZONE:
- Check appropriate box(es) DON’T miss the Previous Injury!
FIRST AID RENDERED:
- On Hill – we always do a Urgent Survey (U/S), thus always put it down. Then add other aid given:
ie, quick splint, sling, bandage, Sager, O2,
etc. Put name of patroller who
did it. NOT CALL SIGN!
- In Aid Area: Since we always do a Nonurgent Survey (N/S), put it down! Plus, any other aid given.
Again, put name, not CALL SIGN.
- Check the appropriate box of how Pt. got to the First Aid room. (other – put walk-in if applicable)
TRANSPORT & DESTINATION:
- Check the appropriate box and IF by ambulance put the departure time and check AM or PM.
EQUIPMENT:
- Check one: Alpine, Nordic, Snowboard or Other
- Check one: Owned, Rented, Borrowed, Other
- If rented: (If not rented - N/A entire area)
from DSR: from other:
Area Rental #: DSR Name of shop, or UNKNOW
Shop Name: DSR Name of shop, or UNKNOW
Binding model get info from ski or board get info from ski or board
Type skis get info from ski or board get info from ski or board
(or board) (K2, Burton, Atomic, Etc.) (K2, Burton, Atomic, Etc.)
- Skis removed by: Even boarders have two feet. So check the appropriate two boxes.
(IF EQUIPMENT IS
RENTED FROM DSR, YOU MUST TAKE ALL THE EQUIPMENT TO THE SKI SHOP FOR
THEM TO CHECK OUT. YOU OR SKI SHOP
(normally they will do this) MUST MAKE A COPY OF THIS REPORT FOR THE SKI SHOP.
)
SKING HISTORY:
- Ability: check one
- Days skied this season: check the appropriate box(es)
- Falls today: check appropriate box
- How many years skied this
area? If 1st
then 1 year, otherwise actual number of years. (must have
entry!)
- Season Pass Holder:
if no – N/A if yes, then – Season pass #
- For all ticket
holders cut off ticket and attach it to this form. Patroller then can go to ticket office and get
another ticket for customer, IF they are returning back to skiing.
SIGNATURE:
- Self explanatory – if a minor, parent should sign form.
SNOW AND WEATHER
- Check off one box in each of the four fields
PATROLLER COMMENTS:
Since we always recommend that every Pt go to see a Doctor, write it down and put in quotes. (ex. “I recommended to Pt that she go to hospital”, or “I recommended to pt that he go visit a doctor”. Also, put down any other comments patient or witness may have said. Listen for “I am a lawyer, Doctor, etc” and note that… “I am going to sue” is another flag. Especially a comment from the Pt. such as, ‘it was all my fault.”, etc.
PATROLLER COMPLETING
REPORT:
- This will normally be the patroller who is taking care of Pt in First Aid room.
- Photo taken: Check either YES or NO and if yes, fill in By Whom, Date, & Time or if NO, put N/A in
the three spaces. Red Flag incidents require photos. Red Flag – review Red Flag binder for complete
details, but any lift incident is a Red Flag.
- Name – Print name & sign form in appropriate lines…
- Patrol Number: This is your NSP number NOT CALL SIGN (Ex – F063-164907)
- Before signing, completely
review every blank, check mark box, etc for accuracy and that every item has
info or N/A.
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- Staple all related
forms and ticket together and place completed report in rack.
- Have another patroller review form for completeness.
- Give customer the pink copy, only if they ask for it… don’t offer it! Notice PATROLLER COMMENTS are not on the pink copy. This has to be filled out but not necessarily before the pt reviews this it.