Visitor Incident Form

Please fill this form out to report an incident that has happened on Canal & River Trust property (this includes towpaths, canals, rivers, reservoirs or buildings for example).

1. Details of the person reporting the incident

Title (optional)

First name

Last name

Telephone

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Address line 1

Address line 2 (optional)

City

Postcode

2. Details of incident

When did it happen?

Exact location of incident

What happened?

Did anyone need hospital treatment?

Yes

Don't know

Were the police informed?

Yes

Don't know

3. Details of injured person

First name (optional)

Last name (optional)

Email address (optional)

Telephone (optional)

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Address line 1 (optional)

Address line 2 (optional)

City (optional)

Postcode (optional)

Age (optional)

4. Details of injuries and damages to property/equipment

Details of injuries

Details of damage to property or equipment

Your privacy:

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