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Incident Report
Use this form to submit information relative to your incident.
Incident Report
Report Filled By
*
Urban Kayaks Employee?
Yes
No
Phone
Email
Date of Incident
MM slash DD slash YYYY
Location of Incident
Time of Incident
:
Hours
Minutes
AM
PM
AM/PM
Brief Description of Incident
Reason for Incident
First Responder
Was There an Injury?
Yes
No
If Yes, Describe Injuries
Comments
This field is for validation purposes and should be left unchanged.
Δ
Chevron down
For UK Staff Only
Urban Kayaks Customer?
Yes
No
If No, Outfitter Name?
Waterriders, Kayak Chicago
Customer / Paddler Name
Customer Email
Customer Phone
Date of Incident
MM slash DD slash YYYY
Product Start Time
:
Hours
Minutes
AM
PM
AM/PM
UK Response Time
:
Hours
Minutes
AM
PM
AM/PM
Paddle Tested
Yes
No
If Yes, Tester Name. If No, Explain
Jet Ski Operator
Crossing Guard
Manager on Duty
Witness Statement
Photo / Video of Incident
Max. file size: 10 MB.
Phone
This field is for validation purposes and should be left unchanged.
Δ
