教练意外事故报告

TXSNOW

ACCIDENT REPORT

Instructors – please complete this form in the event of an accident or injury to yourself while on course.

教练们- 如果你自己受伤了，请填写此表格：

Instructors – please complete this form in the event of an accident or injury to yourself while on course. 教练们- 如果你自己受伤了，请填写此表格Do you have another employer? / 您是否有其他的雇主？ *Employee number / 员工号Date of Accident / 意外日期和时间： *DateTimeWas the injury sustained outside your province of residence? If YES, please indicate where you "Elect" to open your claim 受伤是否发生在居住省外，如果是的话，请填写事故发生省Please describe the exact circumstances of the event / 请详述具体事故如何发生的 *In case of occupational disease, describe when and how exposure occurred / 如果是职业病，请详述具体如何发生的 *Please state ALL injuries reported, indicated right or left, if applicable / 请列出所有报告的伤害，如果适用，请指明是右边还是左边。 *Did Instructor attend a physician or qualified practitioner or clinic? 教练是否去看医生或合格的治疗者或诊所？If YES, please give name and address, if known. 如果是的话，请把姓名和地址发给我们 *How was injury sustained? 受伤是什么造成的？ *请描述其他原因：Last Name and First Name / 姓和名 *电邮 *Address / 住址： *Injury was first reported to employer on / 报告受伤给雇主日期 *Was Ski Patrol called? / 是否报告雪场安全员？ *If no, please explain why / 如未报告，请详述原因 *If YES, patroller's name / 如报告，安全员姓名 *Is there a patroller's report? If yes, please forward a copy. / 如果有安全员报告，请给我们发个报告副本 *

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Did instructor receive First Aid? 教练是否需要急救？If YES to above, please forward a copy of First Aid report. 如果需要，请转发一份急救报告

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Did Instructor go to hospital？教练是否去医院？If YES, please give name of hospital。如果是的话，请给出医院名？ *Type of injury sustained? / 什么类型的伤？ *请描述其他类型的伤： *Area of injury – please check all that apply / 受伤部位，请给出所有相关的部位:LayoutWeather / 天气：Temperature (Celcius) / 温度（华氏度）：Other Conditions / 其他情况：Trail Name / 滑道名字Location / 位置Visibility / 能见度：Snow / 雪况：Ski Area / 滑雪位置Location of class / 学生位置Location of Instructor / 教练位置Other / 其他 *Was any other action taken? If YES, please specify. / 是否当场采取其他措施，如果是的话，请详述LayoutWitness Name / 见证人名字 *Witness Telephone / 见证人电话Witness Address / 见证人地址