Ashbourne & District u3a
| Please submit this report to ADu3a’s Risk Management Coordinator and/or its Secretary as soon as practicable after the accident, incident or illness has occurred in accordance with its Accident Reporting Procedure | |
| Name of Group or Event/Activity | |
| Date of Accident, Incident or Illness & Location | |
| Name of person(s) injured | |
| Brief description of injury/ies or illness | |
| Brief description of how the accident or incident occurred or the circumstances in which the person became ill | |
| Note of medical/first aid treatment given (if any) | |
| Was an ambulance required? | |
| Was it necessary to call any Emergency Contact(s)? | |
| Did the injured or ill person continue with the activity or event? | |
| Names of any witnesses to the accident or incident, or who were present when the illness occurred | |
| Report submitted by: Date: | |