Accident & Injury Report

Accident and Injury Form

The Accident Form is an essential record which is required by law to document and report details of specified club activity-related injuries and incidents.

It enables us to comply with legal requirements under social security and health and safety legislation, and to identify opportunities for improving risk assessment processes including additional safeguards or training.

1. Site where accident took place(Required)

2. Name of person in charge of the session / activity / competition(Required)

3. Full name of the injured person(Required)

4. Injured person's age or date of birth (if known)(Required)

5. What relationship does the injured person have with Vulcan JFC (e.g. Player, Parent, Carer, Volunteer, no direct relationship)(Required)

6. Date of accident / incident(Required)

7. Time of accident / incident(Required)

8. Nature of the accident and incident?(Required)

9. Give details of how and precisely where the accident took place. Describe what activity was taking place, eg. training programme, getting changed, etc.(Required)

10. Give details of the action taken including any first aid treatment and the name(s) of the first-aider(s).(Required)

11. Please select whether any of the following were contacted

Parent / Carer

Ambulance

Police

Fire Brigade

12. Your name (who is reporting accident / incident)(Required)

13. Your email address(Required)

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