Accident Report - Bolton Lads' and Girls' Club

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

Post Code

About the person who had the accident

Who had the accident?

First name

Last name

Occupation

Address

Post Code

About the accident

Accident date and time

Please update to when the accident happened
DD-MM-YYYY HH:MM (24 hour clock e.g. 16:30)

Session type

Where did it happen?

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 how and why 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

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