MileShyClub Incident and Accident Report
Please complete this form to report any incidents, accidents, safeguarding or welfare concerns.
Any urgent or life threatening issues please contact the relevant agency directly, for example, the police or ambulance service.
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Your name:

Your email address:

Your contact number:

Your role within the organisation:

Name and address of injured/affected person (where relevant)
Where incident/accident took place or what the concern relates to.
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Date of incident/accident/or date concern raised
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MM
/
DD
/
YYYY
Give full details of the incident/accident/concern.
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Give full details of any action taken in response to the accident/incident/concern.

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Were any of the following contacted:
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In the event of an accident, what happened to the injured person? (e.g. went home, went to hospital, carried on with session)
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