Mauao Adventures Incident Report Question Title * 1. Person completing report YOUR NAME YOUR ROLES ON THE DAY Question Title * 2. Location Waikōrire (Pilot Bay) Ōwhare (Main Beach) Mauao Lake McLaren Te Papa (The Strand) Other (please specify) Question Title * 3. Date and time of incident Date / Time Date Time AM/PM - AM PM Question Title * 4. Details of the event Activities delivered Senior staff members working Other staff working Group being serviced Number of people in the group Question Title * 5. What was the incident? Tick all relevant occurrences. Injury Medical incident Work equipment damage Damage to other people’s property or the area where activities were performed Other (please specify) Question Title * 6. Detailed description of the incident. Include things leading up to the incident, where in the location it took place, how the incident happened, who played what part, and all other information of relevance. Question Title * 7. What was done to address the incident? Include names of people who played a part in addressing the incident. Question Title * 8. What could be done in future to eliminate or minimise the risk of similar incidents happening again? List any suggested amendments to procedures, equipment to acquire, etc. Question Title * 9. On a scale of 1-5 with 1 being the least likely, rate the likelihood for this occurring again if not addressed. Unlikely Highly likely Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 10. On a scale of 1-5, with 1 being the least severe, rate the level of severity of the incident Minor incident Major incident Clear i We adjusted the number you entered based on the slider’s scale. Done