Alton Hockey Club

First Aid Reporting

In the event of an accident, the following procedure should be followed:

Complete the Accident reporting form for ALL incidents.

* Indicates required field

Name of Person Completing Form *

First

Last

Email Address *

Phone Number *

Today's Date *

Injured Person Details

Name of Injured Person *

First

Last

Address *

Date of Birth *

Select One *

Injured Person (or Parent) Email *

Accident Information: (to be recorded by club/organisation and shared with relevant staff and parents/carers)

Date of Accident *

Time of Accident *

Date Reported *

Time Reported *

Location of Accident *

Injury Details *

Nature and How Accident Happened *

Parents/Carers Notified *

Notified by Whom and When *

First Aid Involved *

Name of First Aider *

First

Last

First Aider Qualified? *

First Aider Email Address *

NOTE By pressing submit below, you are electronically signing this document as the form completer.

Submit