EKRR FC

Accident / Incident Report Form

Complete this form as soon as possible after any accident, injury or significant incident at a Club activity across any Section. Pass the completed form to the relevant Welfare / Child Wellbeing & Protection Officer. Keep the information confidential.

Section & Team

Section (AFC / Youth / Over 35)

Team (if Youth or AFC)

Details of Person Involved

Full name

Age (if under 18)

Role (player / official / parent / other)

Contact number

Parent / Guardian Details (Youth Section only)

Parent / Guardian name

Contact number

Time parent / guardian notified

When & Where

Date of incident

Time

Venue / location

Activity (match / training / event)

What Happened

Describe the accident or incident, including how it happened and any contributing factors:

Injury & Action Taken

Nature of injury (if any)

First aid given?

Was 999 called? (Y/N)

Did the person go to hospital? (Y/N)

Suspected concussion? (Y/N)

Youth-specific

Was a second Official present throughout? (Y/N)

Was the child released only to an authorised adult? (Y/N) 

Any safeguarding concern arising? (Y/N)

Witnesses

Witness 1 – name & contact

Witness 2 – name & contact

Completed By

Name

Role

Signature

Date

For Club Use

Reported to Welfare / Protection Officer (date) 

Reported to Club Child Wellbeing & Protection Officer (Youth Section) (date)

Reported to insurer (if applicable)

Follow-up action / review