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Merton HC accident/incident report
Use this form to record all injuries, incidents or accidents that occur linked to club activities at home venues (Harris Academy Morden or Kings College School), our clubhouse in John Innes Park or at any away venues. 

Additional information may be required for injuries requiring hospital treatment or subsequent visit(s) to a GP.   

This form is automatically saved and sent to info@mertonhockey.co.uk.  It will be reviewed and any appropriate follow-up actions.   Information will be retained for at least 3 years.
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Email *
Your full name (person completing form)
*
Your contact number
*
Name of person involved in the accident/incident *
Age profile of person involved
*
Type of accident/incident
*
Date of incident
*
MM
/
DD
/
YYYY
Time of incident
*
Time
:
Role of injured party
*
Location of accident/incident
*
Description of accident/incident
*
Description of actions taken
*
If person involved is u18, has a been parent notified?
*
Details of parent notification (Who, how, when and any relevant additional info including if they were present at the time of the accident/incident)
Details of any futher action required
Any other comments about incident
Submit
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