PVNT_Incident Report Form

Use this form to report accidents, injuries, medical situations, and other incidents. Incidents involving a crime or traffic incident should be reported directly to the Chelan County Sheriff’s Office. The report should be completed within 24 hours of the event.

Plain Valley Ski Trails Mission: Create and sustain a high-quality ski trail system that serves the community and funds barrier-free ski educational programs that motivate individual and team achievement.

Plain Valley Nordic Team is the ski education program of the Plain Valley Ski Trails, a community supported 501 (c)(3) non-profit public charity. EIN #83-1888658.

Name of Injured Skier

Please select from the following:

Date of Birth

Mailing Address

Parent/Guardian #1 Name

Phone Number

Parent/Guardian #2 Name

Phone Number

Please list medical conditions/allergies or NA

Date of Incident

Location of Incident

Time of Incident

Description of Incident: (Be specific: what happened, how, factors leading to the event?.)

Was the individual injured?

Was medical treatment provided?

Name of Witness #1

Phone Number of Witness #1

Name of Witness #2

Phone Number of Witness #2

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Name

Event Registration Software by RegFox

PVNT INCIDENT

REPORT FORM

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