Incident Report

We take all accidents and near misses very seriously. By completing this Incident Report Form you will help improve the safety on future Club Rides. These reports alert us to areas we can improve as a Club or things for us to focus on Skills and Technique Sessions.

This Incident Report will be submitted to the Club Committee for review. It will also be forwarded to British Cycling for their records. All reports will be treated in confidence.

We hope that you make a quick recovery and are back on the bike soon.

Name

First Name

Last Name

Phone

(###)

###

####

Subject

Date of Incident

YYYY

Time of Incident

Hour

Minute

Second

Incident location / venue

Nature of incident

Was there injury to any rider?

Yes

If yes please add details here

Was there damage to property

Yes

If yes please add details here

Incident Report

Please describe the incident in as much detail as possible

Prevention Recommendations

What actions or measure could be taken to avoid an incident of this nature in the future

Was first aid provided

Details of treatment

Contact details for any witnesses

Please include full name, telephone and e-mail where possible

Incident Report

Thank you for reporting this incident. We take all accidents and near misses very seriously.

This Incident Report will be submitted to the Club Committee for review. It will also be forwarded to British Cycling for their records.

We hope that you make a quick recovery and back on the bike soon.

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