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Harrogate Hockey Club - Accident Report Form
Please complete for all accidents that require medical treatment
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* Indicates required question
Full name of injured party
*
Your answer
Contact number of injured party
*
Your answer
Contact email of injured party
Your answer
Is the injured party an HHC member
*
Yes
Other:
What type of injury occured
*
Your answer
Please provide details of how the injury occured
*
Your answer
Where did the injury occur (please provide a specific area)
*
Your answer
How was the injured party treated
*
Medical first aid
Advised to go to hospital
Treated by paramedics
Date of the incident
*
MM
/
DD
/
YYYY
Time of the incident
*
Time
:
AM
PM
Incident witness details. Please provide a name and contact details
*
Your answer
Report completed by
*
Your answer
Date completed
MM
/
DD
/
YYYY
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