Vehicle Incident Report – 2nd Acomb Scout Group

Name of Driver *

In case we need to get in touch to obtain further information about the incident

Name of Leader in charge *

In case we need to get in touch to obtain further information about the incident

Phone Number *

In case we need to get in touch to obtain further information about the incident

Email Address *

In case we need to get in touch to obtain further information about the incident

GSL Email Address *

In case we need to get in touch to obtain further information about the incident

Group name and Section *

For TSA

District *

For TSA

Type of incident *

Date & Time of the Incident *

Date

Time

Date & Time of the Near Miss *

Date

Time

Location of the incident *

Location of the Near Miss *

Number of Children involved *

Number of Adults involved *

Circumstances surrounding the incident *

What was happening, activity, game, free time etc?

Description of the incident (near miss) *

In as much detail as possible please describe what happened, what went wrong and why. The more details you can provide the more useful it will be in trying to prevent similar instances in the future.

Details of any Third party *

Please give details of any Third Party

Details of any Witnesses *

Please give details of any witnesses

Has the GSL Been informed? *

Have District/TSA been informed *

If we deem the incident as reportable we will report it to the relevant parties.

Follow-Up

Please inform me of the outcome of any investigation and resulting policy / rule change