Incident Report Form
THE SQUASH WALES INCIDENT RECORD FORM
| Name of person making referral:
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| Position of person
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Date of referral: |
| Contact details of person making referral:
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| Brief outline of reason for referral, giving date and time of incident:
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Section A: Please complete if referral is specifically related to a child/children |
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| Childs name/s
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Date of Birth: |
| Childs address
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| Parents/carers names and address/es:
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| Record exactly what child/person referring said. Continue a separate sheet if necessary.
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| Actions taken:
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| Section B: Please complete if referral is specifically related to a parent/staff member/volunteer in squash | |
| Persons name
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Age |
| Address
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| Parents address if above named person is under 18.
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| Club details/county/national details:
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| Record nature of referral. Continue of separate sheet if necessary.
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| Actions taken
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