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Accident Form
Form to download and complete is available here

Guidelines for completing the form

Name Forename and Surname
Age Self explanatory
Gender 'Male' or 'Female'
Home/College Address Self explanatory
Postcode Self explanatory
Telephone State your most used telephone number whether this be a landline or mobile number. Please include the area code.
Job Title Student or Staff member or for the non-student the actual occupation of the injured person.
Department/Club Name of person's club
Supervisor/Trip Leader Name of person in charge of the Club
Time and Date of Accident Date of accident
Where did the accident happen? If at home 'Wellsway pitch', or if away, state the location as accurately as you can record.
How was the injured person treated? 'First Aid' or 'Hospital' or 'Other'

If First Aid then factually list what was carried out.

If Hospital treatment was needed, did the injured person remain there for more than 24 hours? ‘No’ or ‘Yes’ Only 'Yes' or 'No'.
Accident or Incident details
Give a full description of what happened including details of any injury or damage
Please include a full explanation covering what, how, who, where, when etc.. It must be very clear as to how the accident happened and what took place, including calling the emergency services.
Describe the action to prevent a recurrence of this type of accident or incident.  Any advice or information where such an accident could be prevented would be useful.
Name of person completing this form Self explanatory
Date form completed Self explanatory

Completed forms should be returned to:

Keynsham Hockey Club
c/o Jess Murray
6 Back Lane
Keynsham
Bristol
BS31 1ET

© 2018 Keynsham Hockey Club