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Name of student
Address of Student
Time and Date of Accident
Time and Date of Accident: Date
Time and Date of Accident: Time
Location of Accident
Description of Accident
Describe measures taken, including any first aid given, by whom. Taken to hospital? Ambulance? Home?
Were parents notified? When? Their names?
Other witnesses to the accident? If so, please provide their name and contact info.
Any other comments?
If serious accident, please call your Sphere Leader or Supervisor immediately.