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: