6. Accident Report Form

Name of individual completing the form

Sports Team/Society

Date

Any Injurys or Accidents Occurred? YES NO

If yes please complete the details below, if no please go to submit form

Consent was given from the injured party to record their personal information: Name YES:

If consent was not given, was the injured party unconscious? YES: NO:

Name of Injuryed Party

Time of injury

Area Where Accident Occurred

Other Venue or specific location

Ambulance Called? YES * NO If yes, Time Called

* Once you have dealt with the incident please ensure you notify the SU Activities Team via email suactivities@chi.ac.uk especially if you have called an ambulance.

Description of the Accident

Details of Injury (Please be specific on type of injury and exact location on body)

First Aid appied

Any Other Action Taken / Relevant Details

When completing this form please try to include as much additional information as you can. Details of surrounding area, contributing factors to the accident and the type of activity being undertaken will all help in ensuring the best possible action is taken.

I understand that when completing this form, my name will be displayed on the email sent, if I am logged in, and that UCSU has a legal responsibility to ensure that all incidents are followed up and investigated, resultantly the name and contact information of the first aider are documented.

Once fully completed please submit the form below