Accident Report Form
Confidential when complete.
Recorders Name:
*
First Name
Last Name
Contact Address:
*
Street Address
Street Address Line 2
City
County
Postcode
Contact Phone Number:
*
Please enter a valid phone number.
Contact Email:
example@example.com
Name of injured person (s):
*
First Name
Last Name
First Name
Last Name
Contact Address:
*
Street Address
Street Address Line 2
City
County
Postcode
Contact Phone Number:
*
Contact email:
example@example.com
Nature of Injury Sustained:
*
First Name
Last Name
Where did the Accident occur: [include: date; time; location; and nature of the accident.]
How did the Accident occur: [include: names; telephone numbers; etc.]
Were there any witnesses to the Accident: [include: names; statements, etc.]
What action was taken: [include: treatment administered, by whom, etc.]
What action was taken: [include: treatment administered, by whom, etc.]
Have the Parents / Carers been contacted?
Yes
No
Does the accident need to be referred to England Golf Governance Dept?
Yes
No
Date
-
Month
-
Day
Year
Date
Time
Signature of recorder:
Data Protection:
WCG LTD and England Golf Governance Department may use the information in this form (together with other information they obtain as a result of any investigation) to investigate the alleged incident and to take whatever action is deemed appropriate, in accordance with their Children and Young People Safeguarding Policy and Procedures. Strict confidentiality will be maintained and information will only be shared on a “need to know” basis in the interests of safeguarding. This may involve disclosing certain information to a number of organisations and individuals including relevant clubs and County bodies, individuals that are the subject of an investigation and/or Statutory agencies such as the Police and Children’s Social Care.
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