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Events
Calendar
Provincial Championships
BC Cup
2020 DH series
BMX
Road Series
XCO Series
XCM Series
Organizers
Event Sanctioning & Registration
Event Organizer Resources
Membership
Registration
Categories & Upgrades
Insurance
Member Insurance
Bike Insurance
Event Insurance
Benefits
Member Lookup
Clubs & Teams
Register Your Club
Register a Club Ride
Find a Club
Youth Clubs
Youth Zone
High Performance
About High Performance
Current Team
Coaches
Training Camps & Projects
Resources
Coaching & Commissaires
Coaching
Find a Coach
Courses
Resources
Staff
Commissaires
Commissaire Resources
About
Disciplines
BMX
Cyclocross
Mountain Bike
Para-Cycling
Road
Track
Board of Directors
Meet the Team
Sponsors
Official Documents
Cycling BC Accident Report Form
Annual General Meeting
Cycling BC Accident Report Form
Accident Report
If an injury takes place, submit this report within 7 days of the accident.
Incident Level
Minor
Major
Injured: Full Name
*
Injured: Phone Number
Injured: Cycling BC Membership #
Date of Accident:
*
Date Format: MM slash DD slash YYYY
Time of Accident:
*
HH
:
MM
AM
PM
Event Type:
*
Cycling BC Club Activity
Cycling BC Competition
iRide Activity
Other
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 Emal
Witness: Full Name
*
Witness: Phone Number
Event Organizer: Full Name
Event Organizer: Phone Number
Was First Aid administered at the scene?
Yes
No
Was an ambulance called to the scene?
Yes
No
What hospital was the Injured Person taken to:
Please list any other relevant information:
Photo / Document Upload
Optional - 24mb max
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
*
Name
This field is for validation purposes and should be left unchanged.