Endurance GB Incident Report Form
Please complete this form for any accidents, incidents or near misses that occur at Endurance GB events
Please state the event where the incident occured *
Your answer
Please give the name of the event organiser, if known
Your answer
Please give the name of the Health & Safety rep for the event, if known
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Please state your name *
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Please give your telephone number *
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Please give your e-mail address *
Your answer
Please state your role at the event *
In what capacity are you completing this report? *
Please give the name(s) of any person(s) involved in the incident, if known
Your answer
Please give the name(s) of any horse(s) involved in the incident, if known
Your answer
Please give the rider number(s) of anyone involved in the incident, if known
Your answer
Please give the class/distance of the person(s) involved in the incident, if known
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Please give the address of the person(s) involved in the incident, if known
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Please a contact number for the person(s) involved in the incident, if known
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Please give a contact e-mail address for the person(s) involved in the incident, if known
Your answer
Please give the date that the incident occurred *
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DD
/
YYYY
Please give the time that the incident occurred *
Time
:
Please give a brief description of the accident, incident or near miss *
Your answer
Please give details of any damage incurred to persons or property as a result of the incident. State "none" if no damage. *
Your answer
Please give details of any treatment that was given and by whom. State "none" if no treatment given. *
Your answer
If applicable, please give details of any precautions taken (eg on the risk assessment)
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Please give details of any witnesses to the incident, including names and contact details where known
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Please give full details of what happened when the accident, incident or near miss occurred. If this information is taken from someone else's witness statement, please make it clear whose statement it is. *
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