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Incident Report

Please fill in one copy of this form for EVERY incident that occurs.  This form must be submitted within 48 hours of the incident occurring.

Position
 Race Director Official Race Crew Coach

Date of incident

Time:

Location:

Please include what happened, the actions taken and the final outcome.

Please list the names and contact information of all witnesses:

Was medical treatment rendered?
 no yes

Was the injured party transported to the hospital?
 no yes

Name and address of hospital