Accident Report Form

Purpose and Description: The primary purpose of these reports and the Annual Report of Accidents in

North American Mountaineering is to aid in the prevention of accidents. The person filling out the form

should be familiar with the circumstances of the accident and, therefore, either the person(s) directly

involved should complete or at least review the form. Full narratives and suggestions for future climbers

are welcomed. If any persons involved wish to remain anonymous, in the cases where no rescue was

involved, the editor will honor that request.

1. Report completed by (names and address or affiliation with accident):

2. Date of Accident:

3. Geographic Location:   

4. Names (or use a number) and ages of person directly involved:

1.                                                                                     Age:

2.                                                                                     Age:

3.                                                                                     Age: 

4.                                                                                    Age:

5.                                                                                    Age:

5. Total Number of Persons in Party or Class:

6. Details of the Accident:

A. [  ] Rock   [ ] Snow   [ ] Ice   [ ] River   [ ] Unknown

B. [ ] Ascending   [ ] Descending   [ ] Unknown

C. Immediate Cause (you may check more than one):

[ ] fall or slip on rock

[ ] piton pulled out

[ ] nut or chock pulled out

[ ] fall or slip on snow

[ ] failed to follow route

[ ] fall or slip on ice

[ ] faulty use of crampons

[ ] falling rock or object

[ ] lightning

[ ] exceeded abilities

[ ] skiing

[ ] exposure

[ ] ascending too fast

[ ] avalanche

[ ] equipment failure (be specific)

[ ] stranded

[ ] illness

[ ] loss of control - voluntary glissade

[ ] fall into crevasse/moat

[ ] other (be specific): __________________________________________________

[ ] unknown

D. Contributory Cause (you may check more than one):

[ ] climbing unroped

[ ] exposure

[ ] exceeding abilities

[ ] failure to test holds

[ ] inadequate equipment/clothing

[ ] inadequate belay

[ ] weather

[ ] poor position

[ ] climbing alone

[ ] failed to follow directions

[ ] place no or inadequate protection  (poorly protected section)

[ ] illness

[ ] darkness

[ ] equipment failure (be specific): _____________________________________

[ ] nut or chock pulled out

[ ] piton pulled out

[ ] no hard hat

[ ] party separated

[ ] other (be specific): ________________________________________________

E. Type of injury (you may check more than one):

[ ] fatality

[ ] acute mountain sickness

[ ] abrasion

[ ] hypothermia

[ ] laceration

[ ] concussion

[ ] high altitude pulmonary edema (HAPE)

[ ] high altitude cerebral edema (HACE)

[ ] sprain

[ ] infection

[ ] heat exhaustion

[ ] psychological

[ ] heat stroke

[ ] fracture

[ ] preexisting condition

[ ] frostbite

[ ] dislocation

[ ] unknown

[ ] other: _________________________________________________________________

7. Experience Level: [ ] none or little (1st year)   [ ] moderate (1-3 years)   [ ] experienced   [ ] other

8. Narrative Description of Accident:

9. Analysis of Accident: What knowledge and techniques will help prevent future accidents?

10. Additional Comments:

Submit to: Jed Williamson: 7 River Ridge Road; Hanover, NH 03775

 

The American Alpine Club

710 Tenth Street - Suite 100

Golden, Colorado 80401 USA

Telephone: +1 (303) 384-0110