A2O Incident form

Date and time of incident

(Required)

:

Near miss or accident?

(Required)

If an accident, please advise how severe

Trail section

(Required)

Location of incident

Include exact location and any landmarks or anything memorable that will assist us to investigate the site.

(Required)

Description of what happened

Include as much detail as possible (include who was involved, weather and what the possible cause was).

(Required)

Trail user

(Required)

Type of bike

(Required)

Injury description

Treatment required

(Required)

Immediate actions taken

(Required)

Were any other vehicles involved? Please describe.

Was an E-bike involved?

Any other comments or details that may assist and prevent this happening again?

Date and time of incident (Required) Day Month Year Hour Minute	:
Near miss or accident? (Required)	Near miss accident
If an accident, please advise how severe	Minor Major Fatal
Trail section (Required)	Section 1: Aoraki-Mt Cook to Braemar Road Section 2: Braemar Road to Twizel Alt Route: Takapō/Lake Tekapo to Twizel Section 3: Twizel to Lake Ōhau Lodge Section 4: Lake Ōhau Lodge to Ōmarama Section 5: Ōmarama to Otematata Section 6: Otematata to Kurow Section 7: Kurow to Duntroon Section 8: Duntroon to Ōamaru
Location of incident Include exact location and any landmarks or anything memorable that will assist us to investigate the site. (Required)
Description of what happened Include as much detail as possible (include who was involved, weather and what the possible cause was). (Required)
Trail user (Required)	Fully guided Supported - self guided Independent - self supported Day trip - local
Type of bike (Required)
Injury description
Treatment required (Required)	First Aid Medical (Doctors) Hospital out patient Hospital (in patient) 111 Emergency services call No treatment required
Immediate actions taken (Required)
Were any other vehicles involved? Please describe.
Was an E-bike involved?	Yes No
Any other comments or details that may assist and prevent this happening again?


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