RACD Accident Form

Rickmansworth & Chorleywood District Incident Report

This form must be used to report any accident, illness/ medication emergency or incident that occurs at any Explorer, Network or District event. It must be completed within 48 hours of the incident occurring and a copy stored in a safe place.
Full name and role of the person reporting the accident or incident*
Full name of person injured or involved in the incident*
Are you reporting an accident, illness/medical problem or a near miss?*

AccidentIllness/ medical problemNear miss
Activity being undertaken at time of the accident*
Date the incident took place*

DayMonthYear
Date
Time the incident took place*

Hour Minutes

AM/PM Option
Where did the incident take place? How did it happen?*
Were there any injuries that required treatment?*

YesNo
Please provide details of the injury, if relevant
First Aid treatment provided
If non-prescription medication was provided, please indicate what medication was given, how much and when
Were the emergency services contacted*

YesNo
Which service was contacted, tick all that apply

PoliceAmbulanceFire BrigadeMountain/ Lowland RescueCoast guard
Was the person taken to A&E, Minor Injuries, Emergency Doctor or nurse or Emergency Dentists?*

YesNoDon't know
If relevant - Who took the casualty for further treatment?
If the person is under 18, have the parents been informed?

YesNoDon't know
If the emergency services were summoned, or the casualty taken for medical treatment, the Scout Association must be informed using The Scout Association Online Incident Reporting Form.
Should be Empty: