ࡱ> 130q`  bjbjqPqP .::  "$$$$$$$hRH   H ]  :  "  " :z, @ + P " "s0RIr II >% , Q $u HH|     \ \   HALIFAX IRISH JUNIORS INCIDENT/ACCIDENT SHEET Incident/Accident Report Form Team Name : Halifax Irish JFC eg U7 Greens: ____________________ Site where accident took place: Name of person in charge of session/competition: Name of injured person: Address of Injured Person: (If different to registration form) Date and Time of Incident/Accident: Nature of incident/Accident: Give details of how and precisely where the accident took place. Describe what activity was taking place (eg training programme, getting changed) Give details of the action taken including any first aid treatment and the names of the first-aider(s) Where the following people informed: Police: Yes No Ambulance Yes No Parent/Guardian Yes No What happened to the injured person following the accident (eg went home, went to hospital, carried on with session)? All of the above facts are true and accurate record of the incident/accident. Signed _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Name (print) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Please give one copy to Parent/Carer of child Please give one copy to Club Welfare Officer, Leanne Whelan (bring it to Monthly meetings) $356TUbt D $ h ʹ۹۹۹۹۹۹ hphbCJOJQJ^JaJ hbhbCJOJQJ^JaJhbCJOJQJ^JaJhia>CJ$aJ$hbhbCJ$aJ$hb3456TU G l ! " # $ h^hgdb & Fgdbgdb ]^gdia>  gdb  m n o p q    K L z { h^hgdb^gdb & Fgdbgdb,1h. A!"#$% @@@ bNormalCJ_HaJmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k(No List3456TUGl !"#$mnopqKLz{0000000000 0 0 0 0 0 000 00000 0000 000 00000 0000000000TUj00j00RA2 @00    8@0(  B S  ?B!B!B\!B\!bb ii8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsplace 0Pvx24Z`RY33=an6Wkl^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH. ^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.=a6Wk                  ia>b@44D44@@UnknownG:Ax Times New Roman5Symbol3& :Cx Arial5& :[`)Tahoma"qh F F F $242QKX)?b2 markwhelan markwhelan  Oh+'0  4 @ L Xdlt| markwhelanNormal markwhelan2Microsoft Office Word@@z+@~+@M+՜.+,0 hp  PURPLE PRINT MANAGEMENT LTD  Title !"#$%&')*+,-./2Root Entry Fu +4Data  1Table]WordDocument.SummaryInformation( DocumentSummaryInformation8(CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q