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Incident / Accident Report Form
Name of person completing this form*
Site where incident took place*
Name of person in charge of session/competition*
Date and time of incident/accident*
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Month
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Year
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Minute
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AM/PM
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PM
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?*
Details of the action taken*
Include any first aid treatment and the name(s) of the first-aider(s).
Home address of injured person*
What happened to the injured person after the accident?*
eg. went home, went to hospital, carried on with session
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