Incident Form

Incident Form

This form is for anyone: players, parents, team/club officials, away team members and members of the community etc. Only the chairman/club welfare officer will see submissions however details may be shared with anyone named on the form unless there are safeguarding concerns.
Name of person completing form

First NameLast Name
Are you over 18?

YesNo
Name or parent/guardian or trusted person

First NameLast Name
Contact number
For under 18s this must be the number of a parent/guardian or trusted person
Email
For under 18s this must be the email of a parent/guardian or trusted person
Type of incident

AccidentNear missSafety concernBullyingDiscriminationSafeguarding/welfare issueDisciplineComplaint
Name of team(s) involved if known
Date of incident

MonthDayYear
If it isn't a particular incident just leave blank
Location of incident
If no particular location just leave blank
Description of incident/concern/complaint
Should be Empty: