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Incident Reports
Incident Report
For internal use only
Basic Information
We encourage you to write out your report in a Word document and save it somewhere private before submitting; this will prevent any loss of information should the internet or your computer stop working.
Visit the following page for instructions on writing an incident report for tips:
How To Write an Incident Report
Name of staff person submitting report
*
First
Last
Email
*
We will email you a copy of your incident report for your records
Enter Email
Confirm Email
Date of the incident (mm/dd/yyyy)
*
MM slash DD slash YYYY
Time of the incident
*
:
Hours
Minutes
AM
PM
AM/PM
Names of those involved
*
Details of the incident
*
Include as many facts as possible: date, time, who was involved, any descriptors (clothing, tattoos, person's appearance), where it occurred, etc. Refrain from including personal opinions or details - that should be discussed with your supervisor during a debrief.
Action Taken
*
Incident reported to: (include the time)
Supervisor
*
Police
Parent - if a child was involved
Doctor
Other
Comments
This field is for validation purposes and should be left unchanged.