INCIDENT/ACCIDENT report form
fIVE wAYS oLD eDWARDIANS sPORTS cLUB
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 took place.
Describe what activity was taking place, for example 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?
Parents/carers Yes c No c
Police Yes c No c
Ambulance Yes c No c
What happened to the injured person following the incident/accident?
E.g., carried on with session, went home, went to hospital etc.
All of the above facts are a true record of the accident/incident
Signed Date
Name
In the event of an accident occurring through insufficient training or faulty equipment/facilities, follow up action to include completion of risk assessment form.
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