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Health And Safety Incident Report Form
To report to the B3C Committee any incident with in the site or during club events.
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* Indicates required question
Email
*
Your email
What Happenend
*
Your answer
Location of Incident
Your answer
Who was injured and how
Your answer
How were they treated
by First aider
by Paramedic/Doctor
Visit A&E treated but not Admitted
Visit A&E Admitted
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Who are you
Your answer
how are you contacted, phone number or e-mail address
Your answer
Any corrective action that my be considered
Your answer
A copy of your responses will be emailed to the address you provided.
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