Camberley Cricket Club
Incident or Accident Reporting Form
Full Name of Submitter
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
*
-
Date and Time of Incident or Accident
*
-
Day
-
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident or Accident
*
e.g. Camberley Cricket Club, Army Ground Aldershot or a specific area within each location (kitchen, bar area, function room etc.)
Type of Incident or Accident
*
Please Select
Injury
Property Damage
Near Miss
Other
Pleased describe exactly what happened
*
Give details of how and precisely what happened, please describe what activity was taking place e.g. training game, getting changed, setting up etc.
Were there any injuries?
*
Yes
No
Names of Injured Person (if any) and extent of any injury
Please only detail what is actually known and avoid any speculation as to the full extent of the injury.
Were there any witnesses?
*
Yes
No
Names and Contact Information of Witnesses (if any)
Please provide name and if available contact information for any witness(es)
Was a parent or guardian contacted
*
Yes
No
If a parent or guardian was contacted, who was that person?
Was any property damaged?
*
Yes
No
Describe Damaged Property (if any)
e.g. entry gate to cricket nets broke, emergency exit door in function room handle broke etc.
Upload Photos or Documents (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Were any of the following contacted?
*
Police
Ambulance
Welfare Officer
Fire Brigade
None
Describe any immediate actions taken or follow-up required
Give full details of the action taken including any first aid treatment provided and the name(s) of the first aid aider(s) if applicable. If any injury occurred please also detail what happened to the injured person following the incident or accident. e.g. went home, went to hospital, carried on with training / playing etc.
Submit Report
Should be Empty: