Incident Report | Hb Hockey

INCIDENT REPORT - HAWKE'S BAY HOCKEY

Please compete this form in the event of an incident / accident at any Hawke's Bay Hockey facility

Injured party details

First name

Last name

Phone

Date of Birth

What team or club are you affiliated to?

Short answer

Particulars of Incident

Date and time of incident

Day

Month

Year

Time

HoursMinutes

Location of Incident

Injured party was;

Type of Incident

If 'Other' please specify

Witness Details

Name

Phone Number

The incident: Please describe what happened.

Nature of any injury (what part of the body was affected and how)

Property Damage (what, if any, property was damaged and how)

Analysis (What do you think caused or contributed to the incident?)

Prevention: (What action has been taken to prevent the incident happening again?)

Prevention part 2: Have all preventative actions been reviewed by management and implemented?

Treatment

Thank you