You must have JavaScript enabled to use this form. Select the item you wish to report - Select - Accident Incident Near Miss Accident Details State what happened Date of accident Time of accident Site of accident Athletics Activity Type - Select - Long Jump Hammer High Jump Triple Jump Discus Javelin Shot Pole Vault Sprint Hurdles 400m Hurdles Steeplechase Sprints Track Endurance Activity Wheelchair Event Seated Throw Fell Trail Running Road Running Physical Preparation Training WarmUp Activity Cross Country Running Other accident_event_category - Select - Property Slip Trip Fall Sporting Injury Struck By Object Other Body Part Injured - Select - Mouth Buttocks Foot Trunk Disc No Physical Injury Chest Upper Arm Lower Leg Hip Multiple Trunk Toes Vertebrae Internal Organs Wrist Hand Eye Abdomen Groin Wrist Multiple Lower Extremities Neck Multiple Injury Multiple Head Injury Thumb Skull Unclassified Upper Back Lumbar Body Systems Disc Hand Lower Arm Shoulder Upper Leg Ankle Arm Knee Whole Body Please select the most appropriate body part injured Type Of Injury - Select - Burn Dislocation Inflamation Loss of Hearing Dizzy Faint Mental Disorder Foreign Body Strain Electric Shock No Physical Injury Rupture Fracture Laceration Crushing Multiple Injuries Freezing Asphyxiation Hernia Sprain ChestPain Stroke Carpal Tunnel Syndrome Bruise Graze Unknown Head Injury None Asthma Attack Cardiac Arrest Other Nature of Injury Was First Aid given? Yes No Was the injured party taken from site of the accident to hospital? Yes No Injured Person Details Injured Person Name Age - None - Under 18 Over 18 Injured person's Club Contact Address Post Code Phone Email Address Near miss or Incident Please state why you consider this to be a near miss State what happened Athletics Activity Type - Select - Long Jump Hammer High Jump Triple Jump Discus Javelin Shot Pole Vault Sprint Hurdles 400m Hurdles Steeplechase Sprints Track Endurance Activity Wheelchair Event Seated Throw Fell Trail Running Road Running Physical Preparation Training WarmUp Activity Cross Country Running Other Athletics Event Meeting Title/Training Venue/Event Name/Club Name: Lead Person/Organiser Event - Select - Competition Training Other Date of incident Time of incident Site of incident Reporting Person Details Contact Name Contact Address Post Code Phone Number Email Address Your Role Status - Select - Athlete Spectator Official Witness Other I declare that the information provided is accurate. Leave this field blank