This form is designed to collect information that occurs when an accident or near miss occurs during a Roncalli sporting activity that may involve staff, students or members of our community.

Injuries that should be reported are those when a player is forced from the court/field due to injury and are unable to take part in this or furture fixtures for a period of time, and professional advice has been obtained (doctor/physio etc).
Date of Injury/Incident *
Time of Injury/Incident *
Where did Injury/Incident occur *
Name of person completing this report: *
Name of person affected: *
What occurred: *
Details of injury *
Action taken to address the injury: *
What do you think is the likelihood of this incident/ injury occurring again? *
How would you rate the severity of this incident? *
See image below for descriptions
Incident Severity Scale
Ignore the Department of Labour (DOL) and National Incident Database references
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