NYRA Incident/Accident Report

Report Form

To be completed in the event of an accident or incident involving an injury to an exercise rider, apprentice jockey, or jockey, at a NYRA facility.

Date of Incident/Accident(Required)

Time of Incident/Accident(Required)

Location of Incident/Accident(Required)

Rider's Name(Required)

First Middle Last

Rider's Telephone Number(Required)

If unable to provide a telephone number for the rider, please provide the trainer’s phone number.

Rider's Badge Number

Rider's Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Rider's Email Address

Transported to Hospital?(Required)

Trainer's Name(Required)

First Last

Trainer's Telephone Number(Required)

Horse's Name

Horse's Owner

Report Submitted By:(Required)

First Last

Telephone Number(Required)

Email Address(Required)