Incident / Accident Report Form


Location

Did the incident occur at Brooklands Sports Club?*

The person completing this form

Name of person completing this form*

The incident

Site where incident took place*
Name of person in charge of session/competition*
Date and time of incident/accident*
:  
Describe what activity was taking place, eg. training programme, getting changed, etc
Who dealt with incident?*
Include any first aid treatment and the name(s) of the first-aider(s).
Were any of the following contacted? *

The person affected by the incident

Name of injured person*
Home address of injured person*
eg. went home, went to hospital, carried on with session

Witness

Name of witness*
Address of witness*

Confirm details and submit

We take the protection of the data we hold about our members extremely seriously and we are committed to respecting your privacy. These notes explain how we may use personal information we collect, how we comply with the law on data protection and what your rights are.

By completing this form, you consent to the storage and processing of your data for the purposes set out below. More information on these issues can be found in the Club's Privacy Policy.

I confirm that all of the above facts are a true and accurate record of the incident/accident

I understand and agree that completing this form may result in the transfer of personal data outside of the EEA

Incident / Accident Report Form


Location

Did the incident occur at Brooklands Sports Club?*

The person completing this form

Name of person completing this form*

The incident

Site where incident took place*
Name of person in charge of session/competition*
Date and time of incident/accident*
:  
Describe what activity was taking place, eg. training programme, getting changed, etc
Who dealt with incident?*
Include any first aid treatment and the name(s) of the first-aider(s).
Were any of the following contacted? *

The person affected by the incident

Name of injured person*
Home address of injured person*
eg. went home, went to hospital, carried on with session

Witness

Name of witness*
Address of witness*

Confirm details and submit

We take the protection of the data we hold about our members extremely seriously and we are committed to respecting your privacy. These notes explain how we may use personal information we collect, how we comply with the law on data protection and what your rights are.

By completing this form, you consent to the storage and processing of your data for the purposes set out below. More information on these issues can be found in the Club's Privacy Policy.

I confirm that all of the above facts are a true and accurate record of the incident/accident

I understand and agree that completing this form may result in the transfer of personal data outside of the EEA