Trail Crew Incident Report - Colorado Trail Foundation

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Volunteer Injury and Incident Report

(This form should only be submitted by the trail crew leader)

Report Submitted By
First Last
Phone
Phone number of the person who creates this report.
Involved Party's Contact Information
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Work Phone
Email
Gender
- Male
- Female
- Prefer Not to Answer
Guardian's Contact Information
Provide guardian information if involved party is under 18.
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Work Phone
Email
Gender
- Male
- Female
- Prefer Not to Answer
Injury/Incident Information
Date of Injury/Incident
MM slash DD slash YYYY
Time of Injury/Incident

: Hours

Minutes

AM/PM
Location of Injury/Incident
Please be as specific as possible.
How did it occur?
Body part(s) injured:
Was intoxication/substance abuse involved?
- Yes
- No
Intoxication = Yes: Please Explain
What action was taken?
Were safeguards or safety equipment provided?
- Yes
- No
Were safeguards or safety equipment used?
- Yes
- No
Comments
This field is for validation purposes and should be left unchanged.

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The Colorado Trail Foundation

122 Halley’s Ave
Poncha Springs, CO 81201

(303) 384-3729
ctf@coloradotrail.org

The Colorado Trail Foundation is a 501(c)(3) tax-exempt nonprofit organization, FedEIN Tax ID 84-1057336.

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