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TXSNOW
ACCIDENT REPORT
Instructor accident report
Instructors - please complete this form in the event of an accident or injury to yourself while on course.
Instructor - If you are injured yourself, please fill in this form:
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
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？
*
Yes 是
No 否
Employee number / 员工号
Date of Accident / 意外日期和时间：
*
Date
Time
Was 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？
Yes 是
No 否
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？
*
Collision 相撞
Fall 跌落
Overexertion 过度劳累
Other 其他
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 ？
*
Yes 是
No 否
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
*
Click or drag a file to this area to upload.
Did instructor receive First Aid? 教练是否需要急救？
Yes 是
No 否
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
Click or drag a file to this area to upload.
Did Instructor go to hospital？教练是否去医院？
Yes 是
No 否
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？
*
Sprain / 拉伤
Bruise / 钝挫伤
Other 其他
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:
Layout
Weather / 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
Layout
Witness Name / 见证人名字
*
Witness Telephone / 见证人电话
Witness Address / 见证人地址
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