Draft Accident Reporting Form

ACCIDENT FORM

“NAME OF CLUB”

COACH IN ATTENDANCE

INJURED PARTY:

• Name:

• Age/DOB

• School

• Address

ACCIDENT DETAILS

 Date:
 Time:
 Exact location:

 Injury:

 How happened:

SEVERITY:
• Minor
• Considerable
• Severe

FIRST AID INVOLVED                                                  YES /  NO

MEDICAL ATTENTION REQUIRED                          YES /  NO

PARENTS INFORMED                                                   YES /  NO
                                 
                      BY WHOM¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬          _____________________________

FORM COMPLETED BY:      _____________________________

REFERRED TO DESIGNATED PERSON                      YES/  NO

DESIGNATED PERSONS SIGNATURE    ___________________

 Fill in 2 copies of the Accident Form (see previous pro-forma) for ALL accidents.
 Make contact with parents/guardians
 One copy of form to incident book/folder.
 Forward 1 copy to Designated person for record keeping/ action required.
 Contact emergency services/ GP if required
 Record in detail all facts surrounding the accident, witness's etc.