Accident Report - Inspire Youth Zone
Please complete a separate form for each person involved in the accident
About you, the person filling in the report
First name
Last name
Occupation
Address
Town/City
Post Code
About the person who had the accident
Who had the accident?
Please select...
Young person
Youth Zone staff
Youth Zone volunteer
Visitor
Contractor
Other - provide details in description below
First name
Last name
Occupation
Address
Town/City
Post Code
About the accident
Accident date and time
DD/MM/YYYY HH:MM (using 24 hour clock e.g. 16:30)
Session type
Please select...
Junior
Senior
Inclusion
Project
Outreach
Other/Not applicable
Where did it happen?
Please select...
Arts Studio
Boxing Gym
Climbing Wall
Dance Studio
Enterprise
Garden
Gym
Health & Wellbeing
Kitchen
Media Studio
Muga Pitch
Music Studio
Outdoor
Radio
Rec Area
Recording Studio
Sensory Room
Skate Park
Sports Hall
Other - provide details in description below
Accident severity
Please select...
Minor - requiring in-house first aid only
Major - requiring medical assessment
Please assess accident severity: Minor - requiring in-house first aid only e.g. bumps, cuts, burns, sprains. Major - serious injuries requiring medical assessment e.g. concussions, fractures.
How did It happen and why?
Please provide as much detail as possible of why and how the accident occurred, during which Youth Zone activity (if applicable)
Details of injury and treatment
Please give details of any injury suffered and treatment given, including name of hospital (if taken) and whether they returned to the Youth Zone
Privacy notice
Personal information collected is necessary to comply with the law.
For further information about how we process your personal information, who we may share it with, and your rights, please read our
Privacy Policy
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