How to use this form

Use this form to record injuries, near misses, conduct issues, safeguarding concerns, venue issues and other incidents connected to club activity.

Do not use this form to collect unnecessary personal information. Record facts, actions and follow-up needs. Store completed forms securely and restrict access to people who need the information.

1. Basic details

• Club name: [Club Name]
• Date: [Date]
• Time: [Time]
• Location: [Location]
• Activity: [Activity]
• Reported by: [Reported By]
• Role: [Role]
• Contact details, if needed: [Contact Details]
• Person completing this form: [Completed By]

2. Incident type

• Injury
• Near miss
• Conduct issue
• Safeguarding concern
• Venue issue
• Public complaint
• Equipment issue
• Weather or environmental issue
• Other

3. People involved

Only record details that are necessary.

• Name or initials: [Name/Initials]
• Role or relationship to activity: [Role/Relationship]
• Parent or guardian informed, if relevant: [Yes / No / N/A]
• Emergency contact used, if relevant: [Yes / No / N/A]

4. Factual summary

Provide a brief factual summary. Include what happened, where it happened, who was involved, who witnessed it and what was said or done at the time. Avoid opinions or speculation.

[Summary details]

5. Immediate action taken

Record what was done at the time:

• First aid given: [Details]
• Activity stopped or changed: [Details]
• Area made safe: [Details]
• Parent, carer or guardian contacted: [Details]
• Venue, council or landowner informed: [Details]
• Emergency services contacted: [Details]
• Other action: [Details]

6. Follow-up needed

Record any next steps:

• Check on injured or affected person
• Repair, remove or replace equipment
• Update risk assessment
• Speak to volunteer, player or witness
• Make safeguarding referral
• Inform committee
• Inform insurer
• Inform venue, council or landowner

7. Escalation

Does this need to be escalated?

• [ ] No
• [ ] Club committee
• [ ] Welfare contact
• [ ] EDGA
• [ ] Venue owner
• [ ] Emergency services
• [ ] Other

Reason for escalation decision: [Reason]

8. Safeguarding note

If this incident involves a child, young person or adult at risk, follow the club safeguarding policy. Do not delay urgent action because this form is incomplete.

9. Record owner

• Name: [Record Owner Name]
• Role: [Record Owner Role]
• Date: [Date]
• Storage location: [Secure Storage Location]
• Review date: [Review Date]