Accident Reporting Form

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Name of Injured Person *

Location of Incident *

Date of Incident *

YYYY

Time of incident *

Time

Name of Coach/Person supervising *

Phone number of injured person (or guardian if U18) *

Email address of injured person *

Area of body injured *

Details of how the incident occurred *

Action taken, including details of any treatment

Guardian Notified (U18) *

Yes

N/A

Ambulance called *

Yes

Injured person unconscious *

Yes

Head injury sustained *

Yes

Injured person attended hospital *

Yes

Does the injured person require a copy of this form? *

Yes

Witness name *

Witness contact details *

I confirm that the details of this form are correct to the best of my knowledge. Please type name to confirm *

Submit

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