Hospital Form Hospital Form Name of person injured(Required)House of person injured(Required)Date of Birth(Required) DD slash MM slash YYYY Date of accident(Required) DD slash MM slash YYYY Time of accident(Required) Hours : Minutes Description of the Accident/Incident(Required)Location of Accident/Incident(Required)Description of Injury Sustained(Required)Ambulance Called(Required) Yes No Time ambulance called Hours : Minutes Time ambulance arrived Hours : Minutes Treatment given by paramedics on scene, if anyIf not taken by ambulance, what travel was used?Hospital NameHospital ward name if admitted, and ward number Treatment received at hospital and any planned proceduresHas the parent and/or guardian been informed?(Required) Yes No Name of person contactedRelationship to studentDetails given and any outcome:Time contacted Hours : Minutes Has any other parents/guardians been contacted? Yes No Name of person contactedRelationship to studentDetails given and any outcome:Any other details you think are relevant?Any safeguarding concerns?Signature of Buckswood member of staff completing this form(Required)Name(Required)Job Title(Required)Date(Required) MM slash DD slash YYYY
