King Edward's School - Report of Accident

Accident report form - pupils

If you are reporting CONCUSSION, don't use this form - instead, go to kes.org.uk/headinjury

If the injured person is an adult, please use kes.org.uk/staffaccident
Name of casualty*

First NameLast Name
Date of accident*

DayMonthYear
Name of the person completing this form*
Is the injured person a pupil, or a visiting pupil?*

KES pupilVisiting pupil

KES Pupil
Year group of pupil*
Form*
What type of activity were you doing when you were injured?*

Normal lessonGames or PE lessonSports practice at lunch or after schoolSports match/fixtureSchool clubFree time - eg break, lunch, before/after schoolSchool tripOther
If a teacher was supervising the activity, state their name*
If no teacher supervising, state 'NONE'

What happened?
Location*
Where were they (what room, which playing field etc) when the accident happened
Activity*
State the sport, activity or subject you were doing at the time
What happened?*
Describe what led to the accident
Injury*
State what injury(ies) they have suffered
Treatment*
Describe what treatment has been provided by the school
Responder*
Which adult provided treatment for you in school?
What is happening next?*

You are going back to the lesson or activityYou have stopped the activity and are staying in schoolYour parents are collecting you and going homeYou are going to straight to hospital from school or where the accident happened (without first going home)
Any other information
If there is anything else you would like to mention, please type it here.
Witness
If an adult witnessed the accident, state their name
If an adult did not see the accident, but a child did see it, state their name
When you have finished, please click the submit button
Should be Empty:

KES Pupil