Location of where accident took place (please be as precise as is possible)
Date and time of accident/ incident
Name of injured person
Which injury was suffered and where on the body?
Give details of how the accident took place.
What type of session was taking place? (eg Tuesday McKenzie, Thursday 6k group, Track Session etc)
Give details of the action taken including any first aid and the name(s) of the people who gave any first aid.
What happened to the injured person after the accident? (eg went home, carried on with session, went to hospital etc)
Was an ambulance called?
—Please choose an option—YesNo
Was the person’s “In Case of Emergency Contact” called?
Name of person leading session
Please give the name of the person who filled in this form
