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Incident Report Form
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Incident Report Form
This form is to be completed and submitted immediately following any incident from which an investigation may follow
Please enable JavaScript in your browser to complete this form.
Your Name
*
First
Last
Team name & age group Incident relates to
Your role or relationship to RSFC:
*
Your contact number
*
Email
*
persons selected give
Name of RSFC volunteer in charge of the activity
*
First
Last
At what Runcorn Saxons FC activity did the incident happen during *
League or Cup Game
Team Training
Other
You can check more than one option
If you selected 'Other' please give details
Location of incident
*
Date of Incident DD/MM/YYYY
*
Time of Incident
*
Which of the following best describes the person or persons you are concerned about or reporting an incident about
RSFC Player
RSFC Parent / Spectator
RSFC Coach
Referee
Opposition Parent / Spectator
Opposition Coach
RSFC Club Volunteer
Other
You can check more than one option
If you selected 'Other' please give details
Name of person or persons in question or if not known a physical description
*
Type of incident
Safeguarding Report
Threatening or aggressive physical behaviour
Discrimination (language or behaviour)
Aggressive play/coaching (including Respect complaints)
Threatening or offensive Language
Refereeing (e.g. referee abuse or performance)
Poor spectator behaviour (including breach of Respect CoC)
Property or venue damage
No harm incident, just sharing FYI
Other
You can check more than one option
If you selected 'Other' please specify details
Your Incident Statement - What happened (keep it factual)
*
Please provide your statement in a chronological order and your distance from any incident(s) that you may have witnessed. For each incident please confirm if your view was unobstructed, or impaired. Please record any offensive language that you heard directly in speech marks (“ “).
By selecting YES and submitting this form you are confirming the above facts are a true and accurate record of the incident
YES
Submit
Once submitted this form will be sent to the Club Secretary for review.
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Home
About Us
About Runcorn Saxons
Kids Football – Reception & Year 1
The Foundation – Sign On Form
Respect
Club Philosophy
Volunteering At Saxons
Volunteer Code Of Conduct
Volunteer Fine Agreement
Joining Sāxons
KEEPAZ Sessions – RSFC GK Coaching
Runcorn Wildcats
Club Downloāds
Teams
Mini Soccer (U7 – U10)
U7 Cwens Girls
U7 Hildfrom Boys
U8 Frecās Girls – Saturday
U8 Hunilblost Girls – Sunday
U9 Cwens Girls
U9 Thānes Boys
U10 Eldors Boys
Youth Football (U11 – U17)
U11 Cwens Girls
U11 Aces Boys
U11 Cempā Boys
U12 Sun Frecās Girls
U12 Fir Girls
U12 Hlāford Boys
U12 Hāfocs Sunday Boys
U13 Sat Frecās Girls
U13 Hyseās Boys
U14 Frecās Girls
U15 Bárhelm Boys
U16 Flānhred Boys
Player Recruitment
Player Sign On 2024/25 (Form 1)
Player Code Of Conduct (Form 2)
Parent/Guardian/Spectators Code Of Conduct (Form 3)
Accident Report Form
Incident Report Form
Club News
Club News
Contāct