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Incident Reporting Form
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Incident Reporting Form

This form MUST be completed for all incidents and near misses. Where first aid has been provided a record of this must also be produced.

Incident

Add your text

Date and time of incident*

Day

Month

Year

Time

:HoursMinutes

Location of Incident*

Type of Incident*

Accident/ Injury

Hazard

Near Miss

Security Incident Report

Loss of Equipment

Name of Reporter

First name*

Last name*

Email*

Phone*

Role of Reporter*

Committee Member

Coach

Leader

Member

Parent/ Guardian of Child Member

Incident Details

Please provide as much detail about the incident as possible*

Please detail how this was managed (if first aid was required record this below)*

Was this reported to the Police (if applicable)

Yes

No

Police Reference Number (if applicable)

Have you reported this on the Paddle UK Incident Reporting Page?*

Yes

No

Person Affected

First Name*

Surname*

Email*

Date of Birth*

Day

Month

Year

Phone*

Address*

Was the individual injured?*

Yes

No

Was first aid required?*

Yes

No

Please summarise any first aid or medical care provided

If anyone else was involved in the incident please record their name, email, role and contact details below.

admin@stourvalleycanoe.club

Stour Valley

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