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Accident Reporting Form
Please use this form to report any accidents.
Thornbury Running Club must report any accidents to England Athletics and we need your help please to collect the information that is required. The form below and the data requested is based on the UKA 'Accident Reporting Form'.
Thank you for your help and for dealing with the accident.
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* Indicates required question
Email
*
Your email
Name of Person Reporting Accident:
*
Your answer
Injured Person Name
*
Your answer
Please state what happened:
*
Your answer
Date of Accident:
*
MM
/
DD
/
YYYY
Time of Accident:
*
Time
:
AM
PM
Location / Site of Accident - please state where the accident happened (please include Post Code or What3Words location if known):
*
Your answer
Athletics Activity Type:
*
Warm Up Activity
Road Running
Cross Country Running
Accident Category:
*
Property Damage
Slip / Trip / Fall
Sporting Injury
Struck by Object
Other
Body Part Injured - Please identify the part(s) of the body injured in the accident:
*
Your answer
Type of Injury - please describe the type / nature of injury sustained e.g. bruise, graze, cut, fracture etc.:
*
Your answer
Was First Aid given?:
*
Yes
No
Was the injured party taken from the site of the accident to hospital?:
*
Yes
No
Anything you would recommend that could have prevented this accident or would prevent similar accidents in the future?
Your answer
Thank you for reporting this accident. We may need to ask for more information when we report to EA. We will get in contact if we do. If you have any questions please contact the Club's H&S Officer on:
hands@thornburyrunningclub.co.uk
A copy of your responses will be emailed to the address you provided.
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