Sports Injury & Incident Report Form
All sports accidents/injuries/incidents which result in an injury of a member of a sports club that occurs during any of the following activities must be reported within at lest 48 hours:-

- An organised sports club match (home and away)
- Training
- Event or endorsed activity
- Travelling to or from the aforementioned activities

This form can be completed by any member of the sports committee.

In cases of near misses, please email details to:

Email address *
Sports Club? *
Your answer
Name of person completing form? *
Your answer
Contact number of person reporting? *
Your answer
Name of injured person? *
Your answer
Contact number of injured person? *
Your answer
Address of injured person?
Your answer
Who got injured? *
Location & address (if known) of accident / incident? *
Your answer
Date of accident/incident? *
Please give a full description of injury/incident? *
Your answer
Which of the following occurred? Please select all applicable. *
Please give name and number of any witnesses? *
Your answer
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