Accident, Incident and COVID-19 Reporting Form
Please use this form to report any accidents, incidents or suspected COVID-19 cases
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1. Names and contact details of harmed parties and/or witnesses of incident *
2. Groupings of harmed parties/witnesses (tick all applicable) *
Required
3. Date of accident/incident/suspected COVID-19 case *
MM
/
DD
/
YYYY
4. Time of accident/incident/COVID-19 symptoms *
Time
:
5. Location of accident/incident/COVID-19 case (e.g. main hall, field, changing room etc) *
6. Telephone numbers of harmed parties *
7. Activity during which the event happened *
8. Details of accident, incident or COVID-19 symptoms *
9. Was an injury sustained? *
10. Was treatment required? *
11. Was equipment or the site itself damaged? *
12. If you answered Yes or Maybe to question 11, please provide more details *
13. Name/role of person reporting accident, incident or suspected COVID-19 case *
14. Telephone number for person reporting event *
15. Email Address for person reporting event *
16. If you are reporting a suspected COVID-19 case please ensure you follow up with results from any COVID-19 testing positive or negative *
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