inc report :: Brooklands Sports Club, Sale

Incident / Accident Report Form

Location

Did the incident occur at Brooklands Sports Club?*

Yes No

The person completing this form

Name of person completing this form*

First Name

Last Name

Phone number of person completing this form*

Email address of person completing this form*

The incident

Site where incident took place*

Address Line 1

Address Line 2

City

County/Region

Postcode

Name of person in charge of session/competition*

First Name

Last Name

Date and time of incident/accident*

Nature of accident/incident*

Details of how and precisely where the accident took place*

Describe what activity was taking place, eg. training programme, getting changed, etc

Who dealt with incident?*

First Name

Last Name

Details of the action taken*

Include any first aid treatment and the name(s) of the first-aider(s).

Were any of the following contacted? *

Police Ambulance Parent/guardian None of the above

The person affected by the incident

Name of injured person*

First Name

Last Name

Home address of injured person*

Address Line 1

Address Line 2

City

County/Region

Postcode

What happened to the injured person after the accident?*

eg. went home, went to hospital, carried on with session

Witness

Name of witness*

First Name

Last Name

Address of witness*

Address Line 1

Address Line 2

City

County/Region

Postcode

Phone number of witness

Email 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?*

Yes No

The person completing this form

Name of person completing this form*

First Name

Last Name

Phone number of person completing this form*

Email address of person completing this form*

The incident

Site where incident took place*

Address Line 1

Address Line 2

City

County/Region

Postcode

Name of person in charge of session/competition*

First Name

Last Name

Date and time of incident/accident*

Nature of accident/incident*

Details of how and precisely where the accident took place*

Describe what activity was taking place, eg. training programme, getting changed, etc

Who dealt with incident?*

First Name

Last Name

Details of the action taken*

Include any first aid treatment and the name(s) of the first-aider(s).

Were any of the following contacted? *

Police Ambulance Parent/guardian None of the above

The person affected by the incident

Name of injured person*

First Name

Last Name

Home address of injured person*

Address Line 1

Address Line 2

City

County/Region

Postcode

What happened to the injured person after the accident?*

eg. went home, went to hospital, carried on with session

Witness

Name of witness*

First Name

Last Name

Address of witness*

Address Line 1

Address Line 2

City

County/Region

Postcode

Phone number of witness

Email address of witness

Confirm details and submit

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 Report

Location

The person completing this form

The incident

The person affected by the incident

Witness

Confirm details and submit

Location

The person completing this form

The incident

The person affected by the incident

Witness

Confirm details and submit

Brooklands Sports Club

Email

Sporting sections

Incident Report

Location

The person completing this form

The incident

The person affected by the incident

Witness

Confirm details and submit

Location

The person completing this form

The incident

The person affected by the incident

Witness

Confirm details and submit

Brooklands Sports Club

Email

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