Report Form
Persons who have exposed themselves to great danger
while saving or attempting to save a human life on Swiss
territory
can be nominated as rescuers to the Carnegie
Rescuers Foundation. The Foundation Board periodically
reviews all the acts of rescue brought to its attention and
decides upon the bestowal of an award or the granting of
financial support.
01. Name:
02. First name:
03.
Date of birth:
04. Native place:
05. Marital status:
06. Profession:
07. Town:
08. Postal code:
09. Street:
10. e-mail:
   
11. Site of the rescue act:
 
12.

If the rescue act took place in a body of water, please specify:
a) Name of the river/lake:
 
b) Breadth of the river/lake:
 
c) Depth of the river/lake:
 
d) Water temperature:
 
e) Distance from the bank:
 
f) Attire of the rescuer:
 
13. A brief account of the rescue act:
 
14. Dangerous rescue act yes/no:
  yes no
15. What kind of danger:
 
16. Any damage to property:
 
17. Any other remuneration/reward:
 
18. Comments:
 
19. Your mailing Address:
 
 

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