Borough of Rockaway

Borough of Rockaway Municipal Seal

Recreation Accident Report

This form must be submitted within 48 hours of the accident. DO NOT DELAY REPORTING. Insurance forms will be sent to the injured party. If you have any questions contact the Recreation Director at 973-627-2000 ext. 217.

Accident Report

Accident Information

MM slash DD slash YYYY
Please provide name and address of witness. If providing more than one witness, enter each witness on their own line.
Give a brief description of what occurred, including first aid that may have been applied at the scene of the accident/injury.