GeckoSports Incident Report Form

Incident Details

Program Type

Persons Involved

Incident Details

Type of Incident

Brief factual description only – What Happened, How It happened, Who was involved, Activity being conducted, Environmental conditions (if relevant)
Immediate Action Taken

First Aid

Did the child return to activity?
Further treatment recommended?

Further Action

Follow-up Required

Coach Declaration

I confirm that this report is accurate and factual to the best of my knowledge.
(Date this form was filled out)