File a General Incident Report Thank you for reporting an incident. If there are questions, a Safety Officer or someone else may follow up. This report will be handled confidentially. Some definitions: An Incident is anything that results in injury, damage, or distress. A Near Miss is a situation where you escaped catastrophic harm. That may be rockfall within close proximity to you, an avalanche on an adjacent slope, an unplanned forced bivy, or any close call that seriously threatened you. A Safety Concern is anything that you believe might potentially lead to an incident in the future. This report will be sent to the Mountaineers Safety Committee, all branch chairs, and to the chair of your incident activity as applicable. The name of the submitter is included in the report. Concerned about confidentiality? You may instead describe the incident or concern and email it directly to the Safety Committee Chair at safety@mountaineers.org. = required field Submitter Name Enter your first and last name or the first and last name of the interviewee if you are submitting this report on another's behalf. Submitter Email Enter your first and last name or the first and last name of the interviewee if you are submitting this report on another's behalf. Incident Location Select what location the incident occurred at. Baker Lodge Meany Lodge Stevens Lodge Irish Cabin Property Kitsap Forest Theater Seattle Program Center Tacoma Program Center OTHER - Please describe in Incident Narrative. Incident Type ASSISTANCE PROVIDED: The incident occurred to another group, and your party gave assistance. MAJOR: Emergency medical attention or a call to any search and rescue organization or 911 where emergency personnel responded to the incident. MINOR: An unexpected incident which could be a minor injury not requiring medical attention, equipment failure, or a lost party. NEAR MISS: A situation where you escaped catastrophic harm. This may be rockfall within two body lengths, an avalanche on an adjacent slope, an unplanned bivy or any close call that seriously threatened you. SAFETY CONCERN: A potential problem that could cause an incident in the future. SIGNIFICANT: Non-emergency medical attention or a call to any search and rescue organization or 911 where the dispatch was canceled. Incident Category Please indicate a top-level category that best fits this incident, safety concern, or near miss. Hit, struck (or near miss by falling objects)Slip, trip, fallIllnessPersonal issues (conditioning, conduct, lack of skill)Logistics, equipment issues, party issuesBoat/kayak mishapOTHER - Please describe in Incident Narrative. Behavior Was there inappropriate problem behavior connected to this incident? Yes No TO DETERMINE IF A BEHAVIOR COMPLAINT SHOULD BE FILED, REVIEW THE Behavior Complaint POLICY. IF AN INCIDENT OCCURRED in conjunction or as a result of problem behavior, PLEASE COMPLETE A BEHAVIOR COMPLAINT FORM. Terrain Choose the type of terrain where incident occurred. Inside a building or structureGym, artificial climbing walls, sports areaDeveloped spaces, campgrounds, fieldsRoadTrailOff-trail, cross-countryOTHER - Please describe in Incident Narrative.Rock - talus, boulders, screeRock - non-technical, scramble skills neededRock - technical, rope & protection neededSnow - non-technicalSnow - steep, ice axe, poles recommendedSnow - technical, glacier, rope neededIce - technicalWater - large bodies, fresh or saltWater - stream, creek, river Weather Choose the most relevant weather condition at the time of the incident. Sunny, pleasantCloudyWet - rain, showersStormy - wind and rainSnowWindyVery hotVery coldOTHER - Please describe in Incident Narrative. Time of Day What was the time of day that the incident started? Midnight - 6am6am - NoonNoon - 6pm6pm - Midnightn/a Incident Narrative Please describe the incident in your own words. Identify any contributing factors. Try to keep it brief, objective and avoid names if possible. Lessons Learned Upon reflection, what might have been done differently to have avoided or mitigated what occurred? What actions taken may have contributed to positive outcomes? Attachment 1 (optional) A photograph, Word, PDF, zip file, etc. may optionally be attached to provide additional details for the Safety Committee. Attachment 2 (optional) A photograph, Word, PDF, zip file, etc. may optionally be attached to provide additional details for the Safety Committee.
File a General Incident Report Thank you for reporting an incident. If there are questions, a Safety Officer or someone else may follow up. This report will be handled confidentially. Some definitions: An Incident is anything that results in injury, damage, or distress. A Near Miss is a situation where you escaped catastrophic harm. That may be rockfall within close proximity to you, an avalanche on an adjacent slope, an unplanned forced bivy, or any close call that seriously threatened you. A Safety Concern is anything that you believe might potentially lead to an incident in the future. This report will be sent to the Mountaineers Safety Committee, all branch chairs, and to the chair of your incident activity as applicable. The name of the submitter is included in the report. Concerned about confidentiality? You may instead describe the incident or concern and email it directly to the Safety Committee Chair at safety@mountaineers.org. = required field Submitter Name Enter your first and last name or the first and last name of the interviewee if you are submitting this report on another's behalf. Submitter Email Enter your first and last name or the first and last name of the interviewee if you are submitting this report on another's behalf. Incident Location Select what location the incident occurred at. Baker Lodge Meany Lodge Stevens Lodge Irish Cabin Property Kitsap Forest Theater Seattle Program Center Tacoma Program Center OTHER - Please describe in Incident Narrative. Incident Type ASSISTANCE PROVIDED: The incident occurred to another group, and your party gave assistance. MAJOR: Emergency medical attention or a call to any search and rescue organization or 911 where emergency personnel responded to the incident. MINOR: An unexpected incident which could be a minor injury not requiring medical attention, equipment failure, or a lost party. NEAR MISS: A situation where you escaped catastrophic harm. This may be rockfall within two body lengths, an avalanche on an adjacent slope, an unplanned bivy or any close call that seriously threatened you. SAFETY CONCERN: A potential problem that could cause an incident in the future. SIGNIFICANT: Non-emergency medical attention or a call to any search and rescue organization or 911 where the dispatch was canceled. Incident Category Please indicate a top-level category that best fits this incident, safety concern, or near miss. Hit, struck (or near miss by falling objects)Slip, trip, fallIllnessPersonal issues (conditioning, conduct, lack of skill)Logistics, equipment issues, party issuesBoat/kayak mishapOTHER - Please describe in Incident Narrative. Behavior Was there inappropriate problem behavior connected to this incident? Yes No TO DETERMINE IF A BEHAVIOR COMPLAINT SHOULD BE FILED, REVIEW THE Behavior Complaint POLICY. IF AN INCIDENT OCCURRED in conjunction or as a result of problem behavior, PLEASE COMPLETE A BEHAVIOR COMPLAINT FORM. Terrain Choose the type of terrain where incident occurred. Inside a building or structureGym, artificial climbing walls, sports areaDeveloped spaces, campgrounds, fieldsRoadTrailOff-trail, cross-countryOTHER - Please describe in Incident Narrative.Rock - talus, boulders, screeRock - non-technical, scramble skills neededRock - technical, rope & protection neededSnow - non-technicalSnow - steep, ice axe, poles recommendedSnow - technical, glacier, rope neededIce - technicalWater - large bodies, fresh or saltWater - stream, creek, river Weather Choose the most relevant weather condition at the time of the incident. Sunny, pleasantCloudyWet - rain, showersStormy - wind and rainSnowWindyVery hotVery coldOTHER - Please describe in Incident Narrative. Time of Day What was the time of day that the incident started? Midnight - 6am6am - NoonNoon - 6pm6pm - Midnightn/a Incident Narrative Please describe the incident in your own words. Identify any contributing factors. Try to keep it brief, objective and avoid names if possible. Lessons Learned Upon reflection, what might have been done differently to have avoided or mitigated what occurred? What actions taken may have contributed to positive outcomes? Attachment 1 (optional) A photograph, Word, PDF, zip file, etc. may optionally be attached to provide additional details for the Safety Committee. Attachment 2 (optional) A photograph, Word, PDF, zip file, etc. may optionally be attached to provide additional details for the Safety Committee.