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HPH Incident/Accident Report Form
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* Indicates required question
Person in charge of the session/competition:
*
Your answer
Injured person:
*
Your answer
Date of incident:
*
MM
/
DD
/
YYYY
Location of incident:
*
Your answer
Nature of injury / accident and extent:
*
Your answer
Give details of how and where the incident took place and what activity was taking place at the time:
*
Your answer
Give full details of any first aid treatment carried out and the full name(s) of any first aider(s) involved:
*
Your answer
Were any of the following contacted:
*
Next of Kin
Police
Ambulance
None of the above
Other:
Required
Give details of what happened to the injured person after the incident:
*
Your answer
All of the above facts are a true record of the incident / accident:
Signed:
*
Your answer
Name:
*
Your answer
Date:
*
MM
/
DD
/
YYYY
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