SPORTS INJURY INVESTIGATION FORM
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.
Date of Injury/Incident *
Your answer
Time of Injury/Incident *
Time
:
Where did Injury/Incident occur *
Your answer
Name of person completing this report: *
Your answer
Name of person affected: *
Your answer
What occured: *
Your answer
Details of injury *
Required
Action taken to address the injury: *
Your answer
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
Submit
Never submit passwords through Google Forms.
This form was created inside of Roncalli College. Report Abuse - Terms of Service