SBTC Training Incident Report
Use this form to report Hazards, Near Miss and Injuries experienced during training.

Please give as much information as possibly relating to the incident and any injuries or damage sustained as well as any treatment offered and/or given by other club members, club coaches and / or members of the public.

The Club Committee will need this information to respond to this incident and hopefully try to avoid similar incidents in the future.

All responses and the information contained in them will be treated confidentially, and you will receive an email confirmation when you submit this form. Please keep that information confidential particularly in relation to any injuries suffered by other club members or members of the public.
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Email *
Your Name *
Date of Birth
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Your Contact Details - Phone Number *
Incident Details
What are you reporting *
When did it happen (date)? *
MM
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DD
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What time did it happen?
Time
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Where did it happen?
Description of incident *
Description of any injuries sustained, including who was involved - SBTC members or members of the public *
Please provide details of any injuries to either SBTC members or to members of the public. If there were no injuries reported by anyone involved at the time of the incident, then please state that.
Details of injured person *
Please provide details of any injured person(s) including SBTC members or members of the public including full name and their contact details (if available). If there were no injuries reported by anyone involved at the time of the incident, then please state that.
First aid / medical treatment provided (if required) *
Please provide details of any first aid or medical treatment provided to any injured person - whether that assistance was provided either by SBTC members or by members of the public. If there were no injuries reported by anyone involved at the time of the incident, or if the injured person(s) was offered treatment and refused that treatment, then please state that.
Description of any damage to equipment or property *
Please provide details of any damage to any property or equipment belonging either to SBTC members or to members of the public or public property (e.g. someone's car or home, road signs, council infrastructure, etc). If there was no damage noted or reported by anyone involved at the time of the incident, then please state that.
Witness details (if applicable)
Please provide details of any person(s) who witnessed the incident (including both SBTC members or members of the public) who may be able to provide additional information. Please include their full name and their contact details (if available). For SBTC club members, the committee should already have their contact details - so names of Club members will be sufficient.
A copy of your responses will be emailed to the address you provided.
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