Cycling BC Accident Report Form

***Form Temporarily Unavailable*** We are currently experiencing a technical issue with our online forms. Our team is actively working to resolve the problem. Please check back again later. Thank you for your understanding and patience. In the meantime, for assistance with submitting an Accident Report, please e-mail insurance@cyclingbc.net.

Submitting an Accident Report

Please provide a detailed record of the facts and any injuries or damages that occurred. Please note the distinction between a ‘minor’ incident and a ‘major’ incident below.

Minor incidents are usually non-life threatening and require minimal medical attention (such as the use of a first-aid kit). For example, this could include bruises, sprains, minor cuts, or strains. Minor incidents are reported for tracking and recording purposes. This also helps coaches or other sports leaders disclose the use of a first-aid kit in case future treatment is needed.

Major incidents are more serious and require extensive medical treatment including emergency care, hospitalization, or surgery. For example, this could include concussions, fractures, dislocations, dental damage, or significant lacerations. Only major incidents will trigger an insurance claim and an insurance adjuster will contact you following a major incident to file a claim—additional reporting and forms may be required by the insurance company.

Accident Report

If an injury takes place, submit this report within 7 days of the accident.

Facebook
This field is for validation purposes and should be left unchanged.
Incident Level*
Please note the distinction between a 'Minor' incident and a 'Major' incident as described above. Only 'Major' incidents will trigger an insurance claim while 'Minor' incidents are reported for tracking and record-keeping.
Injured: Full Name*
Club/Team Name*
Injured: Phone Number*
Injured Email Address*
Injured: Cycling BC Membership #
Date of Accident:*
MM slash DD slash YYYY
Time of Accident:*

Hours :

Minutes

AM/PM
Event Type:*
Event / Activity Name:*
Injury: Summary*
Injury: Full Description
Describe the extent of the injury and the situation leading up to the accident
First Aid Attendant Name
First Aid Attendant Email
Witness: Full Name*
Witness: Phone Number
Event Organizer: Full Name
Event Organizer: Phone Number
Was First Aid administered at the scene?
Was an ambulance called to the scene?
What hospital was the Injured Person taken to:
Please list any other relevant information:
Photo / Document Upload
Optional - 24mb max
Max. file size: 50 MB.
Digital Signature*
This form must be completed as much as possible, and be submitted to Cycling BC within 7 days of the injury. If available, please attach any reports from the first responder. This document and its contents are privileged; they were prepared in anticipation of litigation. For additional correspondence, email insurance@cyclingbc.net.
- Yes - I have completed this form to the best of my ability
Email of Person Submitting Report*