Get Aca Incident Report Form 2014-2025

Completing the Aca Incident Report Form online is essential for documenting incidents accurately and effectively. This guide will lead you through each section of the form, ensuring that you provide all necessary information clearly and comprehensively.

Follow the steps to successfully fill out the Aca Incident Report Form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the date and time of the incident in the designated fields.
3. Fill in the name of the club, its address, and telephone number to identify where the incident occurred.
4. Indicate whether the injured person has other medical insurance by selecting 'yes' or 'no'. If applicable, provide the name of the company and policy number.
5. Select the status of the injured person (e.g., participant, spectator, employee) by checking the corresponding box.
6. Specify if the incident occurred during practice, competition, or another club activity by checking all that apply.
7. Complete the injured person information section by entering their last name, first name, middle name, telephone number, address, age, and date of birth.
8. For minors, provide guardian or parent information, including name and address.
9. Indicate any suspected pre-existing condition that the injured person may have had.
10. Choose the incident location from the provided options such as competition area, parking lot, or restroom.
11. Classify the incident by selecting one of the categories (e.g., facility or event-related, non-injury).
12. Detail the type of incident that occurred by checking relevant options such as slip/fall or assault.
13. Record any medical services that were administered in response to the incident by selecting from the list provided.
14. Specify the primary injury sustained by the person by marking the appropriate category.
15. Indicate the body part that was injured by selecting the applicable option.
16. Describe how the incident occurred in the provided space.
17. Complete the disposition section by noting how the injured person was cared for after the incident.
18. List the witness information, including names, addresses, and telephone numbers.
19. Ensure that a signature from an official with no relationship to the claimant is included, along with the date.
20. Finally, save any changes made to the form. You can download, print, or share the completed form as needed.

Start completing your Aca Incident Report Form online today!