Please record the date, (approx.) time and location of the incident. Record a very brief description of the incident (a single statement by which the incident may be referred as a full description is required later) and record anyone who witnessed the accident ensuring that you have their contact details if not already known.
Please record the names of anyone involved in the incident, the nature of any injuries and note if any injuries were treated by a medical professional. This information may be updated subsequent to the form’s initial completion.
Please provide a detailed description of the how the incident occurred and mention any contributing factors. (light and weather conditions, slippery surfaces, individual vulnerability or unsteadiness.
Please describe the actions taken to address the incident listing the assistance that was provided.
Please indicate what (if any) measures were subsequently taken or might be later taken to avoid a repetition of the incident.
Please add the name of the person completing the report and the capacity in which they made the report (membership Officer, Person in Charge, Committee Officer etc.)
Please leave this blank and it will be completed if the incident is linked to a completed Accident Report Form in the Accident Report Log as, if the incident was an accident leading to personal injury, then an Accident Report Form must also be completed.
