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ESPC Incident Log
ESPC Incident Log
To be completed to report any incident that occurs whilst attending an ESPC activity.
Please respond to all questions that apply to the incident you are reporting.
Incident Report
Date of incident:
Clinic/Activity:
Venue:
Instructor:
Name of person involved in incident:
Name of Pony/Horse
Was the rider unseated?
Yes
No
Did the rider continue riding following the incident?
Yes
No
Did the pony/horse fall?
Yes
No
Was a vet required?
Yes
No
Other Incident (ie. non-riding):
Yes
No
Where did the incident happened:
Time:
Brief account of what happened:
Was medical assistance given?
Yes
No
Is the Parent/Guardian aware?
Yes
No
Form competed by (Full Name):
Thank you for the information
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