Accident report Form

Report of an Accident, Injury, or Dangerous Occurrence

This form is to be completed in order to report any accident, injury, or dangerous occurrence, which occurs during any training and/or games that are associated with Aldridge Netball Club.

It therefore applies to all club members, children, spectators and visitors.

The form should be completed as comprehensively as possible immediately after the accident or incident and forwarded to the Aldridge Netball Committee; please leave blank any of the questions that cannot be immediately answered.

The captain, team manager or coach of the person experiencing the accident or dangerous occurrence, or by the person who took control at the time of the incident should complete the form.

*The section on date of birth, gender etc is for internal statistical purposes only, however for an accident to a visitor the date of birth is required.

1. Details of person experiencing the Accident/Injury or recording the Dangerous Occurrence

Family/Surname:

First/Given Name:

Address:

Post Code:

Phone No:

Club Player: 

Club Member: 

Visitor/Spectator: 

*Date of Birth:

*Gender:

*Disabled:

*Ethnic Origin:

Team Name:

Reason for Visitor or spectator at game/training:

2. Details of the Accident, Injury, or Dangerous Occurrence.

Date:

Time:

Precise Location of the Event:

Detailed Account of what happened:

3 Response to the Event

Person who administered First Aid

Treatment administered:

Was the person taken to Hospital?

Which hospital?

If so by whom?

Parent/Emergency Contact notified.

4. Recording the Event

For completion by Aldridge Netball Club Committee

Date report received:

Date of investigation by committee:

Details of any remedial action taken:

Accident Report Reference No.