Doc 4 – IWIBA Accident Form

Doc 4 – IWIBA Accident Form Irish Women’s Indoor Bowling Association

– Sample Accident Form

Name of Club

Coach in Attendance:

INJURED PARTY

Name:

School/club: Home address:

ACCIDENT DETAILS

Form Completed By:                                                                          Date:                                                                                   Exact Location:                                                                                   Time:

Time Reported:                                                                                   Reported by who:

Nature of Injury:

How accident happened:

Describe what activity was taking place, for example training/ game/getting changed

Name and contact details of witnesses

First Aid Involved? Yes No

Were the following contacted:

Police Ambulance Parents Informed? Yes/No

By whom:

When:

Referred to Designated Safeguarding Officer (DSO)? Yes/No

DSO Signature                                                               Date:

Any further action to be taken?

Has Young Person returned to Signature of Management Representative
NAME OF CLUB?

Yes No

Print name Position