Skateboard Incident Report Form
Please fill out this form to report and document any skateboard-related incident. Your responses will help ensure proper follow-up and safety improvements.
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
Location of Incident
*
Names of People Involved
*
Type of Incident
*
Fall or Slip
Collision with Object
Collision with Person
Equipment Failure
Other
Were there any injuries?
*
No injuries
Minor injuries (e.g., scrapes, bruises)
Serious injuries (e.g., fracture, concussion)
Describe any injuries sustained
Was any equipment or property damaged?
*
No damage
Skateboard damaged
Other property damaged
Describe the damage (if any)
Detailed Description of the Incident
*
Names and contact info of any witnesses
Your contact information for follow-up
*
Submit Report
Should be Empty: