HASLEMERE COMMUNITY RUGBY CLUB
THE CLUBHOUSE, WOOLMER HILL SPORTS
GROUND, HASLEMERE, SURREY, GU27 1QA
Haslemere Festival Incident Report Summary
To be completed and submitted
by the team representatives to the Chairman of the Junior Club
Committee.
Festival Date: _____________________ Report submission
(Please complete at end of your squads festival)
Age group _______
________
Coach __
_______________
Team
representative
________________
First aiders ______________________
______________________________
_______________________
Reference
Visiting team name
Injuries in the game?
How many? How
many stopped playing? Referred?
Match 1 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Match 2 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Match 3 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Match 4 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Match 5 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Match 6 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Match 7 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Match 8 Has v
_______________
Injuries Y/ N
Number ______ Player's left field ______ Hospital Y/N
Special notes:
- If a player left the field through injury -
attach copy of first aid report and file original with team representative
- If an incident was treated and the player
did not leave the field - only the number needs to be recorded for your stats
on this form but an accident report should be filed with the team
representative.
- If St John Ambulance is called for
assistance to your pitch, complete a full incident report.
- If a 999 emergency call is made and an
ambulance is required for casualty evacuation, a full incident report must be
made.
- If the injury is to one the visiting team,
we need to have a report completed if we provide the first aid support and/or
medical evacuation.
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