Maldon Rugby Union Football Club
Accident / Incident Report Form (Please copy this into an email / document)
To be completed in circumstances where an incident may need additional action at a later date or for clarification or investigation
- Site where accident/incident took place:
- Name of person in charge of session/competition:
- Name of injured person:
- Address of injured person:
- Date and time of accident/incident:
- Nature of accident/incident:
- Give details of how and precisely where the accident/incident took place. Describe what activity was taking place, e.g. 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 Patent/Guardian: Yes / No
- What happened to the injured person following the accident/incident? (E.g. went home, went to hospital, carried on with session)
- All of the above facts are a true and accurate record of the accident/incident?
SIGNED………………………………………. DATE……………………………..
NAME………………………………………….
On completion of this form please forward copies ASAP to:
Maldon RFC Safeguarding Officer, Glen Crickmore, glenncrickmore@yahoo.co.uk
