• IWWF INCIDENT REPORT FORM

    This form should be completed by the on-site Safety/Club Official or Event Organizer at the time of an Accident, Injury or Other Incident during An IWWF Sanctioned Event.
  • SANCTIONED EVENT INFORMATION:

  • Federation/Club/Event Organizer’s Name: * 

    Membership #:  *   

    Date(s) of Event: Pick a Date*  Pick a Date*   

    Address/Location of Event:

    *   *   *   * 

      *   

  • SUBJECTS INVOLVED (attach additional reports if more than one person was involved):


  • Nationality/Country: * Federation:

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    Pick a Date
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  • Note: Signed waivers are required for all participants in sanctioned events

  • DESCRIPTION OF ACCIDENT/INCIDENT/INJURY/ILLNESS (check all that apply):

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    Pick a Date
  • Type of Event during which Incident/Injury occurred:   *   

  • Please answer the questions below and make use of the text blocks provided on this form to document additional details of this incident.

  • If so, what rating?     

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  • REPORT PREPARED BY:

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  • ADDITIONAL DETAILS OF ACCIDENT/INCIDENT/INJURY/ILLNESS:

    (Note - text boxes below are auto-fitting and unlimited)

  • FIRST AID TREATMENT AND DISPOSITION:

  • Clear
  • Clear
  • Name, Address and Telephone Number of Hospital or Other Medical Care Facility where transported?

  • Name of Hospital or Facility:

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  • Should be Empty: