Accident & Incident Report

Blackheath Rhinos FC — Please complete this form as soon as possible after the accident or incident. All fields marked as required must be completed.

Date of accident/incident

Time of accident/incident

Time

Location / venue

Person Involved

Name of injured or affected person

Date of birth or age

Team, age group, school or programme

Parent/guardian name (if person is under 18)

Parent/guardian contact number

Report Details

Name of staff member completing this report

Names of any witnesses

Type of incident

Injury

Illness

Near Miss

Behaviour Incident

Safeguarding Concern

Property Damage

Other

What happened?

What injury or issue occurred?

Area of body affected

Accident & Incident Report