HP3 Coaching Team Incident Report Form

Purpose: This form is to document incidents during coaching activities. Accurate and timely reporting ensures compliance with legal requirements (e.g., RIDDOR), aligns with insurance obligations (Protectivity Insurance), and helps improve safety measures.

Name

Name of person completing the form

First Name

Last Name

Phone

Country

(###)

###

####

Date and Time of Incident

Please provide the exact date and time when the incident occurred.

YYYY

Time

Hour

Minute

Second

Location of Incident

Select the location type and provide specific details (e.g., venue name, home training setup for remote coaching).

Text field for location details

Name of Athlete(s) Involved

List all individuals affected or involved in the incident.

First Name

Last Name

Additional names as required

Activity During Incident

Select the activity being performed when the incident occurred.

Details of activity

Nature of Injury or Illness (If Applicable)

Describe the type and severity of any injuries or illnesses sustained.

Type of Incident

Select all applicable categories for the incident.

Injury (e.g., strain, sprain).

Medical issue (e.g., fainting, shortness of breath).

Dangerous occurrence (e.g., equipment failure, hazardous weather).

Occupational disease (e.g., severe dermatitis).

Environmental hazard (e.g., unsafe surface).

Data breach or confidentiality issue.

Other (please specify).

Specify 'other'

Description of Incident

Provide a detailed account of what happened, including the sequence of events and contributing factors.

Immediate Actions Taken

Describe any first aid, emergency procedures, or immediate measures implemented.

Witnesses

List any witnesses to the incident, including their contact details if follow-up is needed.

RIDDOR Compliance

Determine if the incident is reportable under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations). Refer to RIDDOR guidelines for specified injuries, occupational diseases, or dangerous occurrences.

Text field for RIDDOR reference number (if applicable)

RIDDOR requires reporting certain incidents, such as severe injuries, occupational diseases, and equipment-related dangerous occurrences. If unsure, consult the HSE website or HP3 Head Coach for guidance.

Follow-Up Actions Required

Outline any next steps, such as medical referrals, equipment checks, or athlete follow-up.

Additional Comments

Provide any other information relevant to the incident.

Acknowledgement

I confirm that the information provided is accurate to the best of my knowledge.

HP3 Coaching Team Incident Report Form

Next Steps