Charles Owen - making the world a safer place




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accident report form

Please use this form in a horse related accident. The information may be used by the British Horse Society in association with the Queens Medical Centre for research to improve the safety of the horse world. Thank you for taking the time to fill in this form.

Date and time of accident (dd mm yyyy hh):

Location of accident including country:

Name of person involved:

Age of person involved:

Gender of person involved:

Age of horse involved:

Size of horse involved:

Gender of horse involved:

Activity engaged in at the time of the accident:

Safety equipment used, detailing make & model:
(eg. hat, body protector, safety boots, reflective wear, lights)

Date of helmet purchase:

Please give a detailed description of the accident:

Please describe the nature and extent of the injuries and treatment received:

Please include name of Hospital or General Practitioner:
(if you are willing to have a Medical Advisor contact them)

How long was it before you were able to ride?

Your name:

Your address:

Your email address:

Your telephone number:

If you would like a copy of this form, please enter an e-mail address below: