Netball Incident Report

All injury/incidents/near misses relating to SportUNE's netball competitions MUST be reported as soon as reasonably practicable.

For Insurance purposes, injury reports must be completed within 72 hours of the incident occurring.

Incident Details

What are the details of the incident

Incident date

dd/mm/yyyy

Incident time

Please include specific time AM or PM

Reported by

Report date

dd/mm/yyyy

Location

Please be exact e.g Campbell hall court 2

Incident description

No names in this section please

Immediate action taken

What happened at the time immediately after the incident

Witness information

Witness full name

Witness contact number

Phone

Witness email address

Injury details

Injured persons name

Twilight Team Name

Contact number

Phone

Email address

Injury type

If "other" please explain

Please explain what the injured person was doing

Please explain what happened

First Aid/Medical Treatment

First Aider's name

Treatment given on site

Other treatment details

Date first aid medical treatment

dd/mm/yyyy

Doctor/Medical Centre/Hospital

Please add as much information as possible

Doctor contact details

Send me a copy of my responses