Toggle navigation Load unfinished survey Resume later default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. SoK Incident Report Personal Information Information of individual involved in incident Name Contact number (cell preferred) Email address (if known) Information of person reporting incident Name Contact number (cell preferred) Email address Name(s) of other(s) involved Incident Information Date and Time of Incident Date format: d.mm.yyyy HH:MM Open date/time selector Format: d.mm.yyyy HH:MM 1900-01-01 2187-12-31 23:59:59.999 D.MM.YYYY HH:mm Location of Incident Incident Details (events leading up to and including incident) (This question is mandatory) Activity Type Choose one of the following answers Please choose... SoK Course SoK Lab S.M.I.L.E. Kinderskills AAA Cardiac Rehab Practicum Outdoor Course SIAM mLAB Other: Other: kinesiology@acadiau.ca kinesiology@acadiau.ca Actions Taken First Aid (describe action taken) Hospital (describe action taken) Fire Department (describe action taken) Police (describe action taken) Parent/Guardian contacted (describe action taken) Other action (describe action taken) Suggestions to prevent re-occurrence Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×
