Purley Bowls Club

PURLEY BOWLS CLUB - ACCIDENT REPORTING FORM

 

Name of person in charge of the session/competition: …………………………………….

Site/Venue where the accident/incident took place:

…………………………………………………………………………………………………………

 

Date and time of accident/incident: …………………………………………………………….

 

Name of Injured Person: …………………………………………….

 

Address: ………………………………………………………………………………………………………….

 

………………………………………………………………………………………………………………………

 

Post Code: …………….  Tel: ……………………………………………….

 

Give details of how and precisely where the accident/incident took place. Describe what activity was taking place e.g. training, match, getting changed etc. ……………………………………………………………………………………………………………..……………

………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………

 

Result:

·         Was first aid administered?

 

No ……………….

Yes ………………                          By whom? ……………………………..…………………….

 

Treatment: ……………………………………………………………………………………………………….

……………………………………………………………………………………………………………..……….

 

·         Were any of the following people contacted?

 

Police:                                     Yes                              No

Ambulance:                              Yes                              No

Parent/carer/guardian:              Yes                              No

 

What happened to the injured person following the accident/incident? e.g. went home, went to hospital, carried on with session etc. ………………………………………………………………………………………………………………..

 

All the above facts are a true record of the above accident/incident

 

 

Signed ………………………… Print Name………………………………… Date ……………….

 

Copy to Club Welfare Officer:    Yes/No

 

In the event of an accident/incident occurring through insufficient training or faulty equipment/facilities, the follow up action taken should include the completion of a Risk Assessment.