Injury Report Form
(Office Use Only)
First Name of injured person
Surname Name of injured person
Date of incident
Time of incident
Cause of Injury/accident
Circumstances of injury/accident
Nature of injury/accident including first aid assessment
Level of Consciousness
Fully Conscious
Drowsy
Unconscious
Details of treatment and action taken
Was the ambulance services contacted?
Yes
No
First Aiders Name
First Aiders Signature
*
Clear
Was next of kin notified?
Yes
No
Name of next of kin?
Advice to next of kin
Location
Oakleigh (Waverley Gymnastics Centre)
Moorabbin (Edge Gymnastics Centre)
Murrumbeena (Chamford Gymnastics Club)
Windsor (State Gymnastics Centre)
Name of person in charge
Today's date
Submit
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