Incident Reports

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
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
Email
This field is for validation purposes and should be left unchanged.

Basic Information