Accident Reporting Form
Name and Location of facility *
Full name of the coach supervising the session *
Full name of the injured person *
Full address of the injured person *
Age of the injured person *
Date of accident *
Time of accident *
Nature of injury, including location on body *
Nature of any injures/after-effects which developed later *
FULL details of the accident including; how it happened, what activity was being performed, where it happened (if off pitch) *
Witness name(s) and address(es) *
Action taken *
Police called? *
Ambulance called? *
Facility manager informed? *
Facility accident book completed? *
Parent informed? *
Details of first aid given *
Other actions? *
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