Incident Report

This report must be completed immediately following an incident. 

Incident Report


Game Number


Home Team


Role (player, coach, referee, ect...)


* Address

Name of legal guardian (if under 18)

Incident date


Time of accident

How did the incident happen?

Describe the injury

First aid performed by:

Describe the treatment

Was the injured person taken to hospital? If yes, by who?

Who notified them?

At what time were they notfied?

Witness to incident

Telephone num.


Witness to accident

Telephone num.


* Confirmation e-mail

Please specify the e-mail address to use to send an e-mail confirming that this form was submitted. A digital copy of the form and your data will be sent to you at this address.


Verification code

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