Accident/Injury For all accidents and injuries sustained during Burnie City Church events and programs I am reporting Physical Injury Sickness Dangerous encounter Name of person making report First Name Last Name Contact person making report (###) ### #### Name of Person involved First Name Last Name Age of Person Location of event Date of incident MM DD YYYY Description of Incident Name of witnesses First Name Last Name Were emergency services contacted? * Yes No Was First Aid equipment used Yes No Description of First aid applied Parent Notifed Yes No Thank you!
