
K&K INCIDENT REPORT1712 Magnavox Way P.O. Box 2338 Fort Wayne, Indiana 46801 PH (800) 2372917 Fax (312) 3819077 http://www.kandkinsurance.comWyoming High School Activities Association Concussion.
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How to fill out the WY WHSAA K&K Incident Report online
Filling out the WY WHSAA K&K Incident Report online is an essential process for reporting incidents related to high school activities in Wyoming. This guide provides clear, step-by-step instructions to help users complete the report accurately and efficiently.
Follow the steps to complete the incident report effectively.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill in the 'Nature of Incident' section by selecting the appropriate box for the type of incident, either 'Bodily Injury' or 'Other'.
- In the 'Time & Place of Incident' section, enter the date, event name, event type, and location, along with the time of the incident, selecting either AM or PM.
- Complete the 'Happened To' section by providing the name, Social Security Number, date of birth, sex, phone number, and address of the affected individual.
- Specify the role of the individual in the 'Function As' section by choosing either 'Athlete' or 'Other'.
- Identify the apparent body part and nature of the injury or damage, including whether care was provided on-site or if an ambulance was involved.
- Describe the situation and exact location at the time of the incident in the 'Incident Description' section.
- In the 'Other School Insurance' section, indicate whether your school provides any other accident medical coverage by selecting 'Yes' or 'No' and provide the name of the insurance company if applicable.
- Fill out the 'Insured' section, providing the name of the insured, policy number, WHSAA member school name, and contact details.
- The 'Insured Representative' section should be completed with the name, title, contact information, organization, and date.
- Once all sections are completed, you can save your changes, and then choose to download, print, or share the form as needed.
Complete your incident report online today to ensure timely processing.
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