Incident Report

Age(Required)

Group(Required)

ex. "Usher", "Elder", "None"

Witness Explanation of what happened:(Required)

Place incident took place(Required)

Name of other location(Required)

Date of incident(Required)

What was the person doing prior to the incident:(Required)

Describe the incident (please state if any equipment or objects were involved, and type of injury occurred):(Required)

What actions were performed when the incident occurred:(Required)

Nature of first aid administered:(Required)

Person(s) administering first aid:(Required)

Where were they taken and by whom?(Required)

Name of hospital:(Required)

Who notified the parents?(Required)

Date Completed(Required)