Accident/incident Report

In the case of an accident or incident that has occurred on a P2 Soccer Camp that you would like to report, please fill out and submit the form below. Fill out once for each incident or person.

In the event of an emergency, please call 911.

Camp/Organization/Event Name

Include name of the town the incident occured in.

Name of Person Involved

If they are a minor, please include the minor's name and their Parent/Guardian's name (if applicable).

Role of Person Involved

Phone Number of Person Involved

Name/Phone Number of Witnesses

If you wish to provide signed statements from witnesses, please forward to info@p2.soccer

Type of Incident

Behavioral

Accident

Illness

Other

Date of the Incident

YYYY

Time of the Incident

Best estimate

Describe the sequence of activity in detail including what the affected person was doing at the time of the incident. Please include all relevant information.

Where did the incident/accident occur?

Specify location, including location of injured and witnesses.

Was the Injured participating in an activity at time of injury?

If yes, what activity?

Was there any equipment involved in the accident?

If yes, what equipment?

What could the injured have done to prevent injury?

Emergency procedures followed at time of incident/accident:

Please specify, by whom.

Form Submitted by:

First Name

Last Name