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Accident and Incident Book
For recording accidents, incidents, near misses or any other concerns ocuring on or as a result of GoodGym activities.
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* Indicates required question
Your full name
*
Your answer
Your role in relation to GoodGym
Participant
Area activator
Run leader
TaskForce member
Partner or funder
Member of the public
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Your details
The details of the person reporting the accident.
Please indicate the city, town or borough where the accident, incident or near miss happened
*
Your answer
The accident, incident, near miss or concern
Details of the incident you're recording.
When did the accident / incident happen?
(Time and date)
*
Your answer
Where exactly did the accident / incident happen?
*
Your answer
What caused the accident / incident?
*
Your answer
Did the accident / incident result in an injury or harm being caused?
*
If so describe the injury.
Your answer
Name of the person who had the accident / incident
*
Your answer
Role of the person who had the accident / incident
*
Your answer
Risks and mitigations
What was done on the session to reduce the likelihood this happening?
How might we avoid this type of accident or incident happening again?
Your answer
Do you have any other thoughts or things that should be noted about this accident or incident?
Your answer
What is your email address? This optional. In some cases it may be beneficial to contact you in order to discuss what happened.
Your answer
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