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Incident Report

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  2. Town of Castle Rock: Parks & Recreation Incident Report
    First Report of Incident. After submitting this form, staff are to print off and sign completed report and turn in hard copy to your supervisor.
  3. Was an injury reported?*
  4. Was Police Notified?*
  5. Was EMS Notified?*
  6. Emergency Contact Notified*
  7. Injured/Affected Party
    This section is information identifying the injured/affected party.
  8. Gender*
  9. xxx-xxx-xxxx
  10. Emergency Contact
    This section is information identifying the emergency contact of the injured/affected party.
  11. Relationship to injured/affected party
  12. Side of Body Injured
  13. Part of Body Injured
  14. Code
  15. Care Provided
  16. Include any facts related to this incident and details of care provided. The system will not allow inappropriate language to be submitted. Please abbreviate where appropriate.
  17. Incident Location
    Check all boxes that describe the area in which the incident took place.
  18. Program Type*
  19. Where did the incident take place?*
  20. School Facilities
  21. Locker Room/Restroom
  22. Athletic Venue
  23. Aquatic Space
  24. Fitness Areas
  25. Event Venues
  26. Rooms/Offices
  27. Activity Areas
  28. Witness Information
    Please include information from witnesses of the incident.
  29. xxx-xxx-xxxx
  30. xxx-xxx-xxxx
  31. Staff Completing this Form
  32. xxx-xxx-xxxx
  33. Hard Copy Signature/Date
    ___________________________________________
  34. Supervisor
  35. Supervisor Signature/Date
    ___________________________________________
  36. Leave This Blank:

  37. This field is not part of the form submission.