Motorsports Incident Report - Naughton

About Us
Motorsports
Amusement

Report a Claim
- Motorsports
- Amusement

About Us
Motorsports
Amusement

About Us
Motorsports
Amusement

Motorsports Incident Report

Insured Information

Insured:

Address:

Contact Person:

Phone:

Email:

Incident Information

Date & Time of Incident:

Happened During:

Practice Race

How Did Incident Happen:

Witness Name:

Address/Phone

Location:

Track Pits Grandstands Bleachers Infield Parking Area Other

Other explain:

Injured Party

Name:

Address:

Phone:

Date of Birth (Age):

Name of Parent, if Minor:

Nature of Injury:

Type of treatment given on site:

Was ambulance transport required:

Yes No

If yes, hospital transported to:

Was further treatment recommended?

Yes No

Did party sign waiver?

Yes No

Any photos of area/accident?

Yes No

Any video of area/accident?

Yes No

Name of person filling out this form:

Please print this page through your browser before hitting submit.

Send all information immediately after incident to:

Naughton Insurance Inc.
P.O. Box 6192, Providence, RI 02940.
(401)433-4000 Fax (401)433-5460
info@naughtoninsurance.com

Click here for a printable version

Menu

About Us
Motorsports
Amusement

Menu

About Us
Motorsports
Amusement

Claims

Report a claim
Motorsports Incident Report
Amusement Park Incident Report

Quick Links

Request a Quote
Privacy Policy

Addresses:

Physical Address: -1365 Wampanoag Trail,
East Providence, RI 02915

Mailing Address: -P.O. Box 6192,
Providence, RI 02940

Email: info@naughtoninsurance.com
Tel: 401-433-4000
Fax: 401-433-5460

Lastudioicon-b-facebook

Lastudioicon-b-twitter

Lastudioicon-b-instagram

Lastudioicon-b-dribbble

NAUGHTON INSURANCE, INC. ALL RIGHTS RESERVED ©2024

Start typing and press Enter to search

View more