Incident Report Form

In this section

Team Hallam Incident Report Form

Your name:

Date of incident:

Time of incident (approx):

Sports Club Involved:

Location of incident:

Please give exact address (if known)

Do you think the incident had the potential to cause

death or very serious injury?

Yes

No

Please describe what happened and any action taken

Give as much detail as you can in the text box below, or alternatively,

upload a statement or diagram

Please describe any action already taken to prevent similar incidents

occurring in the future:

Did the Emergency Services attend?

Yes

No

Did a First Aider attend the incident?

Yes

No

Witness name and contact number (if applicable):

About the injured person (if injury was sustained):

Name

Student ID

Contact Number

Description of injuries sustained:

Please give as much detail as you can