Sport | Incident Report

Sport | Incident Report

All injury/incidents/near misses relating the SportUNE's team sport 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?

Team Sport

Select or enter value

Incident date*

Incident time*

Please include specific time + AM or PM

Reported by*

Name of person filling out this form

Report Date*

Todays date

Location*

Venue

Exact location

e.g. field number, canteen, etc.

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 mobile number*

Witness email address*

Injury Details

Injured persons name*

Phone*

Email*

Injury type*

Select or enter value

If "Other" please explain

Injury/incident description*

The exact location of the body that was injured i.e. left, right, etc.

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

Doctor/Medical Centre/Hospital

Please add as much information as possible.

Doctor contact details

Send me a copy of my responses

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