Theme Park Ride Malfunction Incident Report
Report and document details of any ride malfunction or incident at the theme park.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Ride Name or Identification
*
Location of Incident (Area/Section of Park)
*
Description of the Malfunction or Incident
*
Were there any injuries or property damage?
*
No
Yes, injuries only
Yes, property damage only
Yes, both injuries and property damage
If yes, please describe injuries or property damage (if none, enter N/A)
*
Were emergency services contacted?
*
Yes
No
Names and roles of persons involved (staff, guests, etc.)
*
Witnesses (names and contact information, if available)
Immediate actions taken after the incident
*
Your Name (person reporting)
*
First Name
Last Name
Your Contact Information (phone or email)
*
Submit Report
Should be Empty: