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NZ Departures
Van Rentals
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Christchurch
Queenstown
Australia
Media Presence
Discover
About Us
Gallery
Videos
Blogs
Travel Guidelines
Faqs
Privacy Policy
Downloads
Contact Us
Home
NZ Departures
Van Rentals
Day Tours
Auckland
Christchurch
Queenstown
Australia
Media Presence
Discover
About Us
Gallery
Videos
Blogs
Travel Guidelines
Faqs
Privacy Policy
Downloads
Contact Us
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INCIDENT REGISTER INVESTIGATION FORM
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INCIDENT REGISTER INVESTIGATION FORM
INCIDENT REGISTER INVESTIGATION FORM
User
(Required)
Date
(Required)
DD slash MM slash YYYY
Time
Hour
HH
1
2
3
4
5
6
7
8
9
10
11
12
Minute
MM
0
15
30
45
AM/PM
AM
PM
Explain
(Required)
Was someone Injured?
(Required)
Yes
No
Treatment
(Required)
Name of Injured Person
(Required)
Address
(Required)
Date of Birth
(Required)
DD slash MM slash YYYY
Contact No.
(Required)
Select Injury Type (Multiple selection)
(Required)
Bruising
Dislocation
Sprain or Strain
Internal
Fracture
Amputation
Laceration or Cut
Burn or Scald Chemical Reaction
Scratch or Abrasion
Foreign Body
Other
Other, specify
Body Part
(Required)
Vehicle / Property damage description for all involved vehicles
(Required)
Vehicles Details
Opponent Car Rego Number
(Required)
Personal Car Rego Number
(Required)
TREATMENT
Name of Person treating
(Required)
Name of Hospital/Clinic
(Required)
How serious it could have been?
(Required)
Minor
Serious
Very Serious
How often is it likely to happen again?
(Required)
Not often
Occasionally
Often
Risk
(Required)
Possible Illness or Injury
(Required)
Controls to eliminate
(Required)
First aid requirements
(Required)
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