Appendix 5: Accident Report Form

Accident Report Form

This form is designed to report incidents/ accidents, as well as near misses. It should be completed by the volunteer who witnessed the incident, was most directly involved or who provided first aid if relevant. Once completed it must be submitted to the Responsible Person in Charge for the event.

Name of Event:

Details of Child

Nature of incident:

[e.g Medical / near miss / behavioural / missing person / loss or damage to property / data loss or breach]

Incident Details

Outcome of event & immediate actions taken

First aid treatment provided and by whom:

Medication given:

Any resulting change of plans or disruption to the programme, if applicable:

Disciplinary procedures enacted:

Form completion details:

(All records should be kept with this document)