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Name of Injured Party
Name of Coach/First Aider
Date & Time of Accident
Details of the Accident (Tell us what happened...)
Did anyone witness the accident? If so, please provide their details below:
Please give details of events after the accident, along with treatments administered by coach/first aider...
Was contact made with an emergency point of contact following the incident? Please confirm the name of the point of contact, the means of communication and the time that the contact was made.
If you have any other information to provide relating to this incident, please do so here.
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