Accident/Incident Report Form

Report Form
Name of person in charge of session/competition
Site where incident/accident took place
Date of incident/accident
Name of injured person
Address of injured person
Nature of incident/injury and extent of injury
Give details of how and precisely where the incident occurred.
Describe what activity was taking place, e.g. training/game/getting changed.
Give full details of action taken during any first aid treatment and the name(s) of first aider(s).
Were any of the following contacted?
Yes F
No F
Yes F
No F
Yes F
No F
What happened to the injured person following the incident/accident?
e.g. carried on with session, went home, went to hospital
All of the above facts are a true record of the accident/incident
In the event of an incident/accident relating to training or faulty equipment/facilities, follow up action should
include informing the committee of the incident/accident in line with the place to play maintenance policy.
Details of this can be found on the website as well as the notice board.