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Incident Reporting Policy

Incident Reporting
Request Certificate of Insurance
Move United Administrative Policies
Risk Management Resources

PLEASE SCROLL DOWN TO COMPLETE AN INCIDENT REPORT FORM

A Disabled Sports USA dba Move United incident report form must be completed by chapters participating in the Move United insurance program to document any unexpected occurrence (injury, sickness, assault, etc.) regardless of whether or not medical attention was required. All appropriate staff and volunteers should be properly trained on this process and the forms should be available at all activity sites. The incident report form must be submitted via the electronic incident reporting form below or by completing a copy of the form FOUND HERE and emailing it to claimcentral@willistowerswatson.com, with a CC to rsemke@moveunitedsport.org. A sample of a properly detailed/completed incident report form can be found below.

Sample Incident Report – No Injury

Sample Incident Report – Major Injury or Illness

Below are the procedures for ensuring proper incident reporting:

  • Complete, in detail, all areas of the report form
  • Provide sufficient details to ensure that anyone who did not witness the incident will be able to understand exactly what occurred
    • Keep all narratives to known facts. Do not speculate on how the injury occurred or  injuries that have not been verified by a trained medical professional (i.e. “kayak fell on Timmy” vs. “kayak fell on Timmy because the last person may not have properly secured it” or “Susie complained of pain in her knee” vs. “Susie sprained her knee”)
    • Use personal names when detailing the incident, avoid the use of pronouns (he, she, they, we)
    • When multiple witnesses viewed the incident, each witness shall complete a separate Incident Report Form to help ensure all details are captured
    • When needed, attach additional pages to completely detail the incident
  • When available, attach all relevant documentation by treatment providers (i.e. ski patrol, lifeguard, paramedic, EMT, etc.)

 

Click here for the Incident Report Training Webinar

 

The completed incident report form along with the Disabled Sports USA dba Move United Waiver & Release Form and Registration Form must be submitted within 24 hours of the incident.

Incident Report Form

  • The "Save & Continue Later" function can be found at the bottom of this report form. If selected, a pop-up notice will provide a unique URL which will allow you to access the form at a later time. The URL will also be sent via email to the Primary Contact listed. Please note before using this feature: DSUSA cannot access partially completed forms or the URLs associated with the forms. Not all browsers work with this feature. We recommend that you test the feature before completing the full form. Another recommendation is to back up your form to a Word Document before submitting.
  • :
  • Chapter Information

  • Injured Person Information

  • Please be as specific as possible. If none, please type "N/A"
  • Parent/Legal Guardian Information (If Injured Person is a Minor or Legally Incapacitated)

  • Injury Information

  • Please choose all that apply
  • Please choose all that apply
  • Incident Information

  • Please be as descriptive as possible and include all relevant information, including: Who was involved (please provide names and roles)? Where were they? What Happened? What was the sequence of events?
  • Response to Incident

  • i.e. Ski Patrol, EMT
  • Witness & Reporter Information

  • Please upload a copy of the individual's properly signed waiver & release
    Drop files here or
  • Please upload a copy of the individual's registration form
    Drop files here or
  • The completed incident report is an internal document and may only be shared with Move United and our insurer.
  • This field is for validation purposes and should be left unchanged.
Save and Continue Later

Move United is a nonprofit, tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code. Donations are tax-deductible as allowed by law.

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