PCA Incident Reporting System

  • PCA Incident Reporting System

    In the event of a fatality, please contact local Police and notify your State Office immediately. This is not the insurance claim form.

  • Activity Details

  •  - -
  • Incident type:*
  • Are you a Club Official or First Aid Officer?*
  • Type of activity:*
  • Discipline:*

  • Injured Person's Details

  • Gender:*
  • Pony Club Australia member type:
  • Rider grade (if relevant):
  • Was the rider wearing a body protector?*
  • Was the rider wearing an air vest?*

  • Safety Issue

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  • Near miss

  • Definition of a Near Miss:

    An incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred. Near misses also may be referred to as close calls, near accidents, accident precursors and, near collisions (horse or vehicle). 
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  • Incident / Fall Details

    (A fall requires a Fall Report to be completed even if no injury occurred)
  • Where did the incident / fall occur?*

  • Witnesses to the Incident

  • Extent of Injury

    This section should be completed by a First Aid officer or Medical Officer or Club Official

  • 1. SIGNIFICANT INJURY

    - Immediate treatment as an in-patient in a hospital

    - Immediate treatment for: 

    • The amputation of any part of his or her body
    • A serious head injury (including Concussion) 
    • A spinal injury
    • A serious eye injury 
    • The separation of his or her skin from an underlying tissue (such as de-gloving or scalping)  
    • Serious lacerations

    In the case of a serious injury or illness, it does not matter whether a person actually received treatment, just that the injury or illness could reasonably be considered to warrant such treatment. 

    For concussion and spinal injury, a Medical Certificate is required to return to sport if the patient is a rider. Patient is to be advised they cannot participate further until clearance received from a medical practitioner. 

    OR

    2. MINOR INJURY - any minor injury that did not result in a fatality or Significant Injury.

    Medical Certificate is not required. First Aid only (if required) & able to return to participation. 

     

  • Significant Injury - select the type of injury related to this incident or near miss:
  • Minor Injury - select the type of injury related to this incident or near miss:
  • Transport to hospital by:
  • Transport to doctors by:

  • Injury Details

  • Reload the Incident Report Form if you cannot view the below image.

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  • Did the injured person receive any First Aid treatment?*

  • Suspected concussion or spinal injury

  • PCA Concussion Policy Information:

    Any rider that suffers a fall or blow to the head should be screened for signs of concussion.

    • The rider should not be left alone following the injury and serial monitoring is essential over the first few hours following the incident.

    • If there are any grounds for suspicion that concussion has occurred, the rider is not permitted to remount and continue riding. The only exception is if the rider has undergone a medical assessment and written consent to continue riding that day is provided by a medical practitioner.

    • Parents have no right to over-ride the decision of the First Aid Officer/medical practitioner - this is for the rider's own safety.

    • Any rider with diagnosed concussion or spinal injury is not permitted to ride at a Pony Club rally/muster or event for a minimum period of 21 days and must be symptom free for the preceding 48 hours.

    • Riders can have a mandatory suspension removed by providing a certificate from a Medical Practitioner stating that full recovery has occurred.

    • Riders diagnosed with concussion should have physical and mental rest until the acute symptoms resolve and then a gradual, stepwise program of increasing activity and medical clearance.


    Click here to download Pony Club Australia’s Head Injury / Concussion PDF form. The form is required to be signed by the Medical Practitioner. It can be uploaded in the box below or provided to the club in order to have the medical suspension lifted. The Medical Practitioner's own form with equivalent information is also acceptable.

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  • Fall Report Form

  • Fall Details

  • Did the fall involve a fence or gate?
  • Provide a description of the fence / gate:
  • Fence associated with water?
  • Did the horse hit the fence on the way up?
  • Did the horse hit the fence on the way down?
  • Did the horse break the fence?
  • Did the horse tip a portable fence over?
  • Did the rider hit the fence?
  • Accident type:
  • Did horse fall on or tread on injured rider?
  • Did the horse somersault?
  • Did the horse slip?
  • Did the horse refuse?
  • Ground conditions:
  • Was a bend involved in the incident?
  • Was a slope involved in the incident?
  • Were any other object/s struck in the incident?
  • Weather type:
  • Was it windy?
  • Was there poor visibility (fog, smoke, mist, sun glare, etc.)?

  • Details of injury/s sustained by the horse

  • Nature of injury/s:*
  • Did a vet attend?*

  • Kindly please reload the Incident Report Form if you cannot view the below image.

  • Your Contact Details

  • Should be Empty: