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Accident & Injury Report Form

SQUASH WALES ACCIDENT FORM

Full Name of injured person:

 

Venue of accident:

 

 

Location of accident:

 

Date of accident: Name of individual/s who dealt with accident:

 

 

 

 

Nature of the accident:

 

 

 

 

 

Details leading up to the accident:

 

 

 

 

 

Details of events after the accident:

 

 

 

 

 

Details of First Aid treatment given:

 

 

 

 

 

   
Responsible Adult

 

Signature:

 

Print Name:

 

Date:

 

First Aider

 

Signature:

 

Print Name:

 

Date:

 

Venue/Site

co-ordinator

Signature:

 

Print Name

 

Date:

 

 

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