WTA Work Party Incident Report
Information about person involved/injured
Name
Email
Address
Telephone
Age
Gender
Incident information
Date
Time
Location
Type
Injury
Illness
Equipment
Near miss
Behavior
Exclusion
Witnesses
Incident
Be SPECIFIC, detailed and factual. Do not editorialize or make assumptions.
Circumstances and actions leading up to the incident:
Describe incident and response:
Actions taken after incident:
Your name
(optional, but encouraged):
Email or telephone:
Name of Chief Crew Leader:
Email or telephone:
Optional comments
Be SPECIFIC, detailed and factual. Do not editorialize or make assumptions.
Witness 1 Name:
Email or telephone:
Witness 1 Comments:
Witness 2 Name:
Email or telephone:
Witness 2 Comments:
Witness 3 Name:
Email or telephone:
Witness 3 Comments:
Name or anonymous source description:
Area for opinions, feelings, assumptions and conjecture. Especially as it pertains to exclusionary incidents (can be from leader, witness or anonymous source).
Thank you for submitting an incident report. WTA staff will review and address as appropriate, and will follow up with you if necessary.
Contact Information