Cricket Incident or Accident Report

(Incidents and accidents which happen at Longparish are to be recorded in the Accident Report Book):

Site where incident or accident took place away from LCC Ground: ….………………………

Name of person in charge of :  ..……………………..…………………………………….………

Name of injured person:  ………………..…………………………………………………………..

Address of injured person:      ………………..…………………………………………..…………

Date and time of incident or accident: ………………..……………………………………………

Nature of incident or accident:  …………………………….………………………………………

Give details of how and precisely where the incident or accident took place. Describe what activity was taking place, e.g. training game, getting changed, etc.

……………………………………………………………………………………………………….....

……………………………………………………………………………………..…………………..

Give full details of the action taken including any first aid treatment and the name(s) of the first aider(s):

………………………………………………………………………………………………….…..….

……………………………………………………………………………………………………………

Were any of the following contacted:

Police:  Yes ¨   No  ¨          Ambulance:  Yes ¨   No  ¨          Parent/carer:  Yes ¨   No  ¨

What happened to the injured person following the incident or accident? (e.g. went home, went to hospital, carried on with session):

…………………………………………….……………………………………………………………

All of the above facts are a true and accurate record of the incident or accident.

SIGNED:                                             DATE:

Name: