Mazama Activity Incident Form

What is an Incident?

An incident is any event that impacted the activity, or any participant in the activity, in more than a minimal or planned-for way. Examples of incidents that must be reported include:

Any illness or injury that requires treatment beyond basic first aid, either in the field or afterward (e.g. sprains or broken bones, but not blisters or colds).
Any activation of search and rescue or the evacuation of a participant
A close call or “near miss” that could have resulted in injury or other adverse consequences (such as rockfall that narrowly missed party members).
A Critical Incident (fatality, multiple injuries)
Assisting non-Mazama parties
Minor behavioral issues, such as failing to follow directions, interpersonal conflicts, ignoring Mazama rules.

Who is responsible for filing an Incident Report?

Mazama activity leaders are required to file an incident report if an incident occurs during a Mazama activity. In addition to the leader, other participants may submit an incident report but are not required to do so.

What Happens Then?

Incident reports are initially routed to three individuals—the Risk Management Committee Chair, a board representative, and the Volunteer & Committee Coordinator. These three individuals receive a full copy of the report and will confer on next steps. The committee that oversees the activity will receive a notice that a report has been filed, but will not receive a full copy of the report.

If you check the box "Inform CISM" the CISM chair will receive a full copy of the report.

Behavioral Incidents / Problem Behavior / Harassment

File any incidents related to behavior, harassment, misconduct, sexual harassment using the Behavioral Incident Form.

Your Information

Your Name *

Your Role *

Phone Number *

Phone Type *

Cell

Landline

Work

Email Address *

Report Date * +

Incident Details

Activity Leader Name *

Team Size *

Incident Date * +

Incident Time *

Location of Incident *

Route/Trail (if applicable)

Weather When Incident Occurred *

Mazama Program (select one) *

Activity (Select One) *

Was outside help needed (e.g. 911, Sheriff, Search & Rescue, etc)? *

Yes

No

Were party members made aware that a Critical Incident Stress Management debrief is available? *

Yes

No

Would you like this report to be sent directly to CISM? *

Yes

No

If a debriefing is requested, would you be willing to share this incident report with the Critical Incident Stress Management team to assist them in preparation (INITIAL if yes)

What was the nature of the incident? *