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Accident Reporting Form

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Accident Reporting Form

Was an injury suffered?*
Injured person:*
Full name of injured person*
First Last
Choir (If child)
Occupation (if employee)
Accident recorded by:
First Last
Same as the person who had the accident?
About the accident
Where did it happen? (Which area of the site e.g dining hall, Routh Hall)
Precise location (eg practice room 2/ concert hall)
When did it happen? Date and time*
What happened? (Describe the sequence of events, injuries caused and if you can, give the cause of the accident)*
Was First Aid given?*
If Yes:
Name of First Aider
First Last
Details of treatment
Witnesses – add the details of any witnesses
Accident type*
If other please give detials
Cause of accident*
Other cause (please describe)
Severity of accident*
Injury*
If other injury (please give details)
Body Part(s) affected*
Was the injured person taken to hospital?*
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