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GCEC Incident Report Form
Gold Coast Equestrian Centre
Incident report
SECTION A: Details of Incident
Name of person completing report:
*
Date incident occurred:
*
Day
Month
Year
Time incident occurred:
Time
:
Hours
Minutes
AM
Incident occurred while:
Location of incident:
*
What happened: (What was happening at the time of the incident? Who was involved? Briefly describe how it happened).
SECTION B: Details of rider, injured person or injury.
Name and surname
Nature of injury (please report all injuries, including minor scrapes and bruises).
Details of treatment provided:
SECTION C: Acknowledgement (A signature confirms that the above details are correct and GCEC has received notification of the above incident has).
GCEC Staff Name
GCEC Staff Signature
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Person named in above incident: (Rider / Injured person)
Signature of person named in above incident: (or parent/guardian if under 18 years of age)
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Submit
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