Old Cranleighan HC - Accident / Incident Report Form

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Notes:
• This form must be completed for all accidents / incidents.
• Full details of OCHC First Aid Policy are here - https://www.ochockeyclub.org/first-aid/

Email *

Name of person completing this form and relationship to injured / impacted person. *

Name of injured person *

Age group and / or team of injured person *

Venue of accident / incident *

Date of accident / incident *

YYYY

Time of accident / incident *

Time

Coach / Captain Name *

Nature of accident / incident and extent of injury *

Is this accident / incident a head injury? i.e. was the head impacted in any way

Yes

Clear selection

Name of individuals who dealt with accident / incident *

Names of all club members and other parties involved incl. witnesses *

Details of action taken incl. First Aid, Hospital Treat etc... *

Were any of the following contacted? *

Doctor

Ambulance

Parent / Guardian / Partner

OCHC Welfare Officer

Police

Does the First Aid bag require items to be replaced? Please detail items below. *

Parent / Guardian / Partner Name (if unsure of partner write don't know). *

Parent / Guardian / Partner Email Address and / or contact number (if unsure of partner write don't know) *

Any other comments

Final declaration ... *

I have completed the above to the best of my ability

I have ensured the parent / guardian or partner has been informed

I have informed the team Captain / Coach on the team that they must read the club's First Aid Policy (https://www.ochockeyclub.org/first-aid/) to ensure they complete their responsibilities

I will email a copy of this form, once received, to ochcfirstaid@gmail.com and the parent / guardian or adult player

Required

A copy of this form will now be emailed to you and the data automatically retained by Old Cranleighan Hockey Club for the purposes on managing the welfare of our member(s) who have been injured and any accident reporting required by England Hockey (https://www.englandhockey.co.uk/governance/duty-of-care-in-hockey/injury-reporting)

A copy of your responses will be emailed to the address you provided.

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