Free Incident Report Template 16Free Incident Report Template 16
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Template Incident Report Form

INCIDENT/ ACCIDENT REPORT FORM
NAME OF CLUB
Name of person in charge of session/competition:
Site where incident/accident took place:
Date of incident/accident:
Time of incident/accident:
Name of injured person:
Address of injured person:
Nature of incident/accident and extent of injury:
Give details of how and precisely where the incident/accident took
place.
Describe what activity was taking place, eg training game, getting
changed, etc.
Give full details of the action taken including any first aid treatment
and
the name(s) of the first aider(s):
Were any of the following contacted:
Police: Yes ❒ No ❒
Ambulance: Yes ❒ No ❒
Parent/carer: Yes ❒ No ❒
What happened to the injured person following the
incident/accident? (eg went home, went to hospital, carried on with
session)

All of the above facts are a true and accurate record of the
incident/accident.
SIGNED:
NAME:

DATE:

In the event of accident occurring through insufficient training or faulty
equip