Incident Report Form

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?



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?



Did a First Aider attend the incident?



Witness name and contact number (if applicable):

About the injured person (if injury was sustained):

Student ID

Contact Number

Description of injuries sustained:
Please give as much detail as you can