Club Sports Accident Report Form
Email
Secondary Email
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Identification Information
Name (person involved in incident/accident) *
Class Year *
ID Number *
Gender *
Male
Female
Incident/Accident Description
Date of Incident/accident *
Sport in which incident/accident occurred *
Location of incident/accident *
Time of incident/accident *
Describe injury (using left, right, etc.) *
Description of incident/accident *
Was immediate first aid administered? (Yes/No) If Yes, describe. *
Was person referred to Health Services? *
Yes
No
Was Safety & Security notified for emergency transport? *
Yes
No
Was person taken to hospital? *
Yes
No
If yes, name of hospital.
Other actions taken at time of injury
Information of person filling out report
Email address *
First name *
Last name *
Cell Phone Number
Submit
* required field