Report an Incident

Club Name

Full Name of Person Reporting Incident

Job Title

Best Phone Number to Reach Person Reporting Incident

Location Address Where Incident Occurred

Address

City

State

Zip Code

Club’s Primary Contact Email

What date did the incident occur?

Is the date you learned of the incident different than the date it occurred?

Yes

Approximately what time did the incident occur?

How many people are injured?

What date did the incident occur?

From whom (and how) did you learn of the incident?

For each injured person, fill out the following information

Full Name	Approximate Age	Injured Party Phone/Mobile	Gender	Club Member?

What type of incident are you reporting?

Pickleball Injury While Playing (not eye related)

Pickleball Eye Injury

Non-Pickleball Related Injury - Trip & Fall Down Steps

Non-Pickleball Related Injury - Trip & Fall Outside

Assault/Fight Incident

Liquor Liability/Drunk Driving Incident

Something Else

What part of the body did the person injure?

Do you have a waiver on file for the injured party?

Upload Waiver

Who else witnessed it and what do they say happened?

What was the injured party's attitude? Select all that apply.

Angry/blaming other players

Angry/blaming us

Embarrassed

Friendly

Scared

Demanding

Had the injured party been drinking alcohol?

Yes

N/A

How long had they been playing prior to the injury?

Do you have their injury on video? Preserve their entire playing time please!

Upload Video

What did the injured party say happened?

Did you or another staff member inspect the playing area after the incident occurred?

Yes

Did you notice any liquids, sticky substances, deformations or the court surface, or any other abnormalities?

Yes

Please upload any/all of the following: injured party(ies) waiver(s), written incident reports, photos of the area the person says they were hurt.

Upload Files

Which eye did the player injure?

Right eye

Left eye

Were the safety glasses the club’s property or the player’s property?

Player’s own glasses

Club’s glasses

Do you have a waiver on file for the injured party?

Upload Waiver

What did the injured party say happened?

Had the injured party been drinking alcohol?

Yes

Were they wearing safety glasses?

Yes

How long had they been playing prior to the injury?

Do you have their injury on video? Preserve the entire playing time please.

Upload File

Who else witnessed it and what do they say happened?

Please upload any/all of the following: injured party(ies) waiver(s), written incident reports, etc.

Upload Files

Where did the person fall?

Had the injured party been drinking alcohol?

Yes

Did the person completing this report witness the fall?

Yes

Did you or another staff member inspect the steps after the incident occurred?

Yes

If you answered yes to the inspection, please describe what you saw or upload an image below

What part of the body did the person injure?

Please explain, by telling a detailed story, what happened.

Did the inspection show any tripping or slipping hazards, or any deterioration of the steps?

Yes

Upload images

Choose File

What part of the body did the person injure?

Had the injured party been drinking alcohol?

Yes

Did the person completing this report witness the fall?

Yes

Approximately what time did they fall?

What was the weather like at the time they fell?

Please explain, by telling a detailed story, what happened.

Where did the person fall?

If the incident happened at night, was the area illuminated by outdoor lights?

Yes

Upload any relevant files

Choose File

What part of the body did the person injure?

Please explain, in detail, what happened.

Was anyone directly involved in the fight served alcohol?

Yes

N/A

Preserve ALL video footage from all public angles from the time any member of the group arrived to the time all parties involved departed, and upload that video here.

Upload videos

Where did the fight/assault occur?

Was there security on duty?

Yes

Preserve ALL receipts for any alcohol served to all parties involved, and upload them here

Upload receipts

Upload any other related assets

Upload files

Important

If someone died, call Cameron Linder (559-360-4695) immediately — even if it’s 3:00 AM! Call twice to override Do Not Disturb mode.

How did you learn about the incident?

Was the driver ever cut off from being served alcohol?

Yes

Does staff remember serving the driver involved in the accident?

Yes

Not sure

Preserve ALL receipts for any alcohol served to all parties involved, and upload them here.

Upload receipts

Preserve ALL video footage from all public angles from the time the driver involved arrived to the time they departed, and upload that video here.

Upload videos

Please upload video, photos, statements, and any other relevant information

Upload files

Note:

Please call Cameron Linder (559-360-4695) during the next business day to discuss further actions.

What part of the body did the person injure?

What happened? Please describe the incident with as much detail as possible.

Upload any relevant images, receipts, or videos

Upload files