Incident Reports - Tim Hortons Iceplex

ABOUT
PLAY
LEARN
COMPETE
TRAIN
CALENDARS
contact
NEWS

Home
Facility Info
Play
Learn
Train
Compete
Tickets

Home
Facility Info
Play
Learn
Train
Compete
Tickets

INCIDENT REPORT FORM

Name Of Rink: Bill Gray's Regional Iceplex
Rink Address: 2700 Brighton Henrietta TL RD, Rochester, NY 14623

* Indicates required field

PERSON COMPLETING REPORT *

DATE OF INCIDENT *

DAY *

TIME *

AM/PM *

AM PM

NAME OF INJURED PERSON *

First

Last

[object Object]

AGE *

MALE/FEMALE *

MALE FEMALE

INJURED PERSON ADDRESS *

CITY *

STATE *

ZIP *

INJURED PERSON PHONE NUMBER *

IF INJURED PERSON WAS A MINOR, WERE PARENTS NOTIFIED? *

YES NO

IF INJURED PERSON WAS A MINOR, WERE PARENT'S PRESENT *

YES NO

EVENT TAKING PLACE ON RINK AT TIME OF ACCIDENT *

HOCKEY GAME PUBLIC ICE SKATE IAHL NEL H101 S101 FS101 SPECIAL EVENT

NAME OF PERSON NOTIFIED *

RELATIONSHIP TO INJURED PERSON *

ADDRESS OF PERSON NOTIFIED *

CITY *

STATE *

ZIP *

PHONE NUMBER *

DESCRIPTION OF INJURY *

HOW DID THE INCIDENT OCCUR? (DESCRIBE ENTIRELY AND FULLY BASED ON THE PATRON'S WORDS) *

TYPE OF AID GIVEN *

WAS INJURED PERSON TAKEN TO HOSPITAL? *

YES NO

IF YES, WHICH HOSPITAL *

IF INJURED PERSON WAS NOT TAKEN TO HOSPITAL, WHAT ACTION WAS TAKEN? *

COMPLETE BELOW IF DURING PUBLIC SKATE

NAMES OF SKATE GUARDS ON SITE: *

APPROXIMATE ATTENDANCE *

Submit

USEFUL LINKS

Book Ice

Facility Schedule

Job Opportunities

Partnership Opportunities

Ultimate Assist

Watch Live

Group Outings

News & Media

Purchase Gift Cards

CALENDARS

Hockey Camps

Public Ice Skating

Skate and Shoot

Special Events

Stick and Puck

BRAND SITES

Guardian's Cup

Iceplex Adult Hockey League

Never Ever League

Rinks to Links Golf Classic

Rochester Golf Expo

ScorZone Golf Center & Lounge

Spring Fling Kidsfest

2700 Brighton Henrietta Townline Rd
Rochester, NY 14623
(585) 424-4625

Join Our Email List

© 2013-2025 | Tim Hortons Iceplex | All Rights Reserved | Privacy Policy | Legal Notice

© 2013-2023 | Tim Hortons Iceplex | All Rights Reserved | Privacy Policy | Legal Notice

ICEPLEX CALENDARS

special events
facility schedule
public ice skating
skate and shoot
open freestyle
adult player development

USEFUL LINKS

public ice skating
birthday parties
learn to ice skate
learn to play hockey
never ever league
adult hockey league
JOB OPPORTUNITIES

CONTACT US

Bill Gray's Regional Iceplex
2700 BRIGHTON HENRIETTA TOWNLINE RD
Rochester, ny 14623

[585] 424-4625

OUR LOCATION

JOIN OUR EMAIL LIST

© 2018 bill gray's regional iceplex