Incident/Accident Report Form – St. Margaret's Badminton Club

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INCIDENT/ ACCIDENT REPORT FORM

Please complete all the fields below

Name of person in charge of session:

Name of club/session:

Site where incident/ accident took place:

Name of injured person:

Address of injured person

Postcode

Telephone Number

Date and time of incident/accident

Date

Time

Give details of how and precisely where the incident/ accident took place:

Full accident details

0 /

Name(s) of first aider(s)

0 /

Phone Number

Where any of the following contacted:

Police:

YESNO

Ambulance:

YESNO

Parent/Care/Guardian:

YESNO

What happened to the injured person following the incident/ accident:

Enter full details here

0 /

All of the above facts are a true and accurate record of the incident/ accident

Please tick to confirm

YES

First and Last Name of person completing this report