Page 85 - OSEP Management Module 5_Neat

AppENDIx

Example and template facility incident report

This sheet is to be used to report incidents including, but not limited to, those that
have caused injury.

Example incident report sheet

Name and Person/s Time and Location Incident Outcome Immediate
contact involved date of of description description action taken (for
details of in incident incident incident (cause) example, ice,
reporter compression,
removal from
field, etc.)

Sharon Jones John Smith 7.30pm, Field 4 Lost footing Injured ankle Game stopped,
999 999 (player) 18/01/07 in large pot with large removed player
hole and fell amounts of from field, ice
heavily swelling and compression
applied

Player registration
details confirmed
and insurance
claim paperwork
provided
Incident reported
to ground
controller after
match

Jim Ryan Bill Ryan 8.45pm, Field 3 Coach Young To be acted on by
(parent) (player) 18/01/07 abused Indigenous the affiliate under
111 111 and Geoff player player the guidelines of
Blake abused by the coach’s code
(referee) coach with of ethics
reference to
race

OSEP MANAGEMENT IN SPORTING ORGANISATIONS TRAINING PROGRAM — LEARNER’S GUIDE OSEP MANAGEMENT IN SPORTING ORGANISATIONS TRAINING PROGRAM — LEARNER’S GUIDE 0