Serious Accident

ReportForm

For use by all Groups

Urban Saints complies with the Data Protection Act 1998.

All of the data given on this form will be held and used in accordance with this Act.

When to use this Form:

For any accident occurring at a Group activity in which any of the following apply:

  • A Leader/Helper/young person receives medical treatment that requires them to stay overnight in hospital.
  • The emergency services are involved.
  • Serious damage to property occurs.

A copy of this form should be completed by a Group Leader as soon as possible and sent to Mark Arnold, Urban Saints, Kestin House, 45 Crescent Road, Luton, LU2 0AH. Mark the envelope ‘Private and Confidential’. (This applies to all Groups in the UK as the Support Centre in Luton may need to contact Urban Saints’ insurers.)

IMPORTANT NOTE:

Group Leaders should ensure that if they retain copies of completed Forms, theseare kept securely and only members of the leadership team have access to them.

Name of Group:

Name of the Group Leader making this report:

Address:

Postcode:

Tel. no: Daytime:Evening:

Accident Report

Date, time and place of the accident:

Give full details of the accident, all actions taken, damage to property, any injuries received and medical/first aid treatment given:

Continued overleaf…

State how and when the parents of any injured young people were informed of the accident:

Give the names, addresses, phone numbers and ages (if under 18) of all witnesses to the accident:

Give the name(s) of the Leader(s)/Helper(s) or other adults in charge of the young people at the time of the accident:

Has any defective equipment involved in the accident been retained? YES / NO

If ‘YES’, where is the equipment being kept, and by whom?

What actions have the leaders taken to ensure a similar accident will not recur?

Any other information that may be relevant:

Signature of Group LeaderDate:

making this report

Urban Saints is the operating name of The Crusaders' Union, a company limited by guarantee and registered inEnglandWales, company number 07771037, charity number 1144923, and in Scotland, charity number SCO39313 –