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Serious Accident Form

PLEASE DO NOT FILL IN THIS FORM IF AN INCIDENT IS ONGOING. PAY FULL ATTENTION TO THE SITUATION AND RETURN TO THIS FORM LATER WHEN YOU ARE CALM AND ABLE TO FILL IT OUT THOROUGHLY **

This form is for reporting incidents that require more than basic first aid like plasters or ice packs.

Details

Student Name(Required)
Coaches Name(Required)
Date of Incident(Required)
Time of Incident(Required)
Time as near as possible to the incident taking place.
:

Specifics of the Incident

Space where incident happened(Required)

Please point out the exact area (as close as possible) where the incident happened.
Please list any other facility, equipment or environmental factors that contributed to this incident
List any witnesses of the incident

About the Injury

Please describe in as short and precise way as possible how the injury happened.

Treatment

Where was the student treated for the injury?(Required)

Was the parent called to pick up the student before the end of class?(Required)
If 'No' was the parent informed at pick up?
Was a member of management team notified of the incident?(Required)

Thank you for sending the form.
We will check it and get back to you if we require further information.