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Incident/Hazard/Pre-check successfully submitted

12:29PM, Thu 11th Aug 2022

INCIDENTINCIDENT

HAZARDHAZARD

PRE SESSION CHECKPRE SESSION CHECK

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REPORT INCIDENT

Incident details

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Participant/Casualty details:

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Area of injury: please select an area of the body below

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Area of injury

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Injury Description

Area of injury:

Current selected injury:

STOP - Check for Concussion!

A player should stop playing/training and not return if:

They have one or more of the following observable signs:

  • Loss of consciousness or responsiveness
  • Slow to get up
  • Unsteady on feet
  • Incoordination
  • Clutching of head
  • Blank or vacant look
  • Dazed/ Confused
  • And/or…

One or more of the following symptoms are present:

  • Headache
  • Seizure or convulsion
  • Dizziness or balance problems
  • Confusion • Difficulty concentrating
  • Nausea or vomiting • Drowsiness / fatigue
  • More emotional or sadness
  • Blurred vision, sensitivity to light
  • Irritable
  • Difficulty remembering or amnesia
  • Neck Pain
  • “Don’t feel right”
Is it a suspected concussion?

All players with a suspected concussion should:

  1. Be removed from play/training immediately.
  2. Have medical attention sought as a priority, if ANY RED FLAGS are reported or develop (consider calling an ambulance).
  3. Be assessed by a Healthcare Professional within 24-48 hours.
  4. Fully complete the appropriate Graduated Return to Play (GRTP) programme even if the symptoms resolve.

Use this link to help you identify “Red Flags” and Headcase Guidance
englandrugby.com/participation/playing/headcase/resources

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Upload photos

You can only upload images currently stored on your device:

  • - Must be in .jpg, .jpeg, or .png format
  • - Maximum file size allowed not more than 6 MB

 

Uploading images of people?

Only upload photos if they are absolutely necessary. You must gain consent from any person shown in images prior to taking or uploading. You must take care to ensure that any images uploaded are appropriate for use/storage and are necessary for the purpose of injury or hazard reporting.

If you cannot confirm consent, then you must not upload images.

The upload of images is carried out entirely at your own risk and Proactive Reporting accepts no responsibility for gaining consent for the image upload, or liability for the appropriateness of images uploaded by users to the system.

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Uploaded photos:

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Incident description

First aid given
Any witnesses
Was additional medical assistance called for?
Parent/Guardian informed?

Reportable injury events

These are defined as:

  • An injury which results in the player being admitted to a hospital (this does not include those that attend an Accident or Emergency Department and are allowed home from there).
  • Deaths which occur during or within six hours of a game finishing.

Clubs and schools are also required to report injuries in which artificial grass pitches or equipment such as sports goggles are involved.

Is the injury an RFU Reportable Injury Event

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REPORT INCIDENT

Incident summary

Group

Date of incident

Time of incident

Venue

Report Completed by

Specific Location

Activity

Incident Type

Participant/Casualty Details

Participant/Casualty Name

Participant/Casualty Age, DOB

Area of injuries

Injury Description

RFU Incident details

Where did injury occur?

Describe incident

Is the injury an RFU Reportable Injury Event

Incident Description

Cause of incident

What happened

First aid given

First aid completed by

Witnesses

Additional Medical Assistance called for

Actions taken to prevent further incidents or risk

Any additional notes

Parent/Guardian informed

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Incident completion


I sign to confirm that the information contained within this report is correct and understand that once submitted it can not be edited

Signature:
Must be signed to continue submitting the report


Are follow up actions required?

 

Hazard successfully submitted

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Hazard details

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Hazard details

Category of hazard help text… Close

Risk Rating help text… Close

 

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Hazard Action

Safe to continue
with controls in place?
Have you informed other affected club volunteers?
Responsible Club Leader informed?
Club Management informed?

 

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REPORT HAZARD

Upload photos

You can only upload images currently stored on your device:

  • - Must be in .jpg, .jpeg, or .png format
  • - Maximum file size allowed not more than 6 MB

 

Uploading images of people?

Only upload photos if they are absolutely necessary. You must gain consent from any person shown in images prior to taking or uploading. You must take care to ensure that any images uploaded are appropriate for use/storage and are necessary for the purpose of injury or hazard reporting.

If you cannot confirm consent, then you must not upload images.

The upload of images is carried out entirely at your own risk and Proactive Reporting accepts no responsibility for gaining consent for the image upload, or liability for the appropriateness of images uploaded by users to the system.

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REPORT HAZARD

Uploaded photos:

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Hazard Action

Any changes made to allow activities to continue?
Any long term action required?
Date to be checked again?

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REPORT HAZARD

Hazard summary

Group

Date of assessment 11/08/2022

Time of assessment

Venue

Report Completed by

Hazard Location

Activity taking place

Hazard Details

Description

Category of Hazard

Risk Rating

Who is at risk

Photos

Safe to continue with controls in place?

Have you informed other affected club volunteers?

Responsible Club Leader informed?

Club Management informed?

Changes made to allow activities to continue

Long term action/future controls required

Date to be checked again

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REPORT HAZARD

Hazard completion


I sign to confirm that the information contained within this report is correct and understand that once submitted it can not be edited.

Signature:
Must be signed to continue submitting the report


Are follow up actions required?

 

Do you wish to submit another hazard report at this location?

PRE SESSION CHECK

Any significant changes since last session?

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PRE SESSION CHECK

Has the facility been checked and are all facility areas safe to use?
Has the equipment been checked and is all equipment safe to use?
Are the players safe to take part (injuries, correct footwear, jewellery taken off)?
Has the pitch / training area been checked and is it safe to use for activity?
Is the activity set up safely with suitable games and skills activities prepared?
Is the activity set up safely through the use of games with a focus on skills development?
Do you have appropriate first aid provision and equipment pitchside?

Signature:
Must be signed to continue submitting the report