ACCIDENT

ACCIDENT FORM

Name of person in charge of session/competition:
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Site where incident/accident took place:
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Date of incident/accident:
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Time of incident/accident:
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Name of injured person:
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Address of injured person:
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Nature of incident/accident and extent of injury:
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Give details of how and precisely where the incident/accident took place. Describe what activity was taking place, e.g. training game, getting changed, etc:
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Give full details of the action taken including any first aid treatment and the name(s) of the first aider (s):
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Were any of the following contacted?
Police:Yes   No
Ambulance:Yes   No
Parent/carer:Yes    No
What happened to the injured person following the incident/accident?
(E.g. went home, went to hospital, carried on with session)
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All of the above facts are a true and accurate record of the incident/accident.
SIGNED: DATE:
NAME:
In the event of accident occurring through insufficient training or faulty equipment/facilities follow up action to include completion of Risk assessment form