Please explain what happened
Include their: full name, date of birth, phone number, email and physical address.
Please provide details about the injury including where it is located on the body, type of injury etc.
You can get them to type it or take notes for them. If they do not want to make a statement or unable to at this time that is fine.
This may include perpetrators of incidents. Visual descriptors such as clothing can be useful. This might include vehicle details.
If any attempt was made to resolve the situation including applying first aid please list that information here.
If so please list their name and role.