Doc 4 – IBA Accident form

Irish Bowling Association – Sample Accident Form

 

Name of Club
Coach in Attendance:
INJURED PARTY
Name:
School/club:
Home address:

 

ACCIDENT DETAILS
Form Completed By:  
Date: Exact Location:
Time: Time Reported:
Reported by who:
Nature of Injury:

 

 

 

How accident happened:
Describe what activity was taking place, for example training/game/getting changed
Name and contact details of witnesses  
 
 
 
First Aid Involved? Yes                        No
Were the following contacted: Police            
Ambulance  
Parents Informed?

Yes            No

By whom:
When:
Referred to Designated Safeguarding Officer (DSO)? Yes                        No
DSO Signature Date:
Any further action to be taken?
Has Young Person returned to NAME OF CLUB?

 

Yes            No

     
Signature of Management Representative

 

 

Print name                            Position

 

 

 

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

 

Signed:                                                                                               Date:                           

 

 

Name:                                                                                    

 

 

(In the event of an accident occurring through insufficient training or faulty equipment/facilities, follow up action to include completion of Risk Assessment Form)

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