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Home
Events
Latest
About
JOIN
Incident Report
General
Incident Location
Injured Person's name
Home Address
Date of Birth
Gender
Male
Female
Occupation
WAWA Number
Event name
Specific location
Details of Injury
Date of injury
Time of injury
Activity in which the person was engaged at the time of injury
Nature of injury e.g. fracture, burn, sprain, foreign body in eye including body location
Details of Treatment
Treatment provided by First Aid Officer
Yes
No
Off site treatment required
Yes
No
Ambulance called
Yes
No
Doctor/Medical Centre attended
Yes
No
Witness information
Name of Chief Judge
Name of Boat Driver
Name of Safety Officer
Name of Event Judge
Signature of Chief Judge
Date