Accident Report Form

Please use this from to report any accident which occurs at Manvers Waterfront Boat Club. Please give as much information as possible - this will help us to investigate and put into place any actions required to keep everyone at the club safe. Please fill in a separate form for each person involved in the accident.

Details about the person who had the accident

* Indicates required field

Name of person who had the accident

Contact Number for person who had the accident

Email address for person who had the accident

Is the person who had the accident a club member?

Address of person who had the accident

Details About The Person Completing The Form

Name of person reporting the accident

Email address for person reporting the accident

I confirm that I have advised the casualty to go to A&E if required

Contact Number for person who had the accident

Address of person reporting the accident

Details About The Accident

Time of the accident

Where the accident occured

Details of Any Injuries & First Aid Administered *

Date of the accident

How The Accident Took Place *

Please upload any photos/information about the accident

Upload

Thanks for submitting!

If you or someone else needs immediate medical attention or you or someone else is at risk of immediate harm or danger, call emergency services for the police or ambulance (999 or 112) immediately.