Incident Report Sample - Free Download | Page 2
4.6,
3756
votes
Please vote for this template if it helps you.
Sample Incident Report
2
Was the above information:
Reported to you by someone else If so, who: __________________________________
OR
Directly observed/witnessed by you
Action(s) Taken: (Check all that apply.)
Provided First Aid What/When______________________________________
Call placed to 911 By Whom________________________________________
Taken to hospital By Whom________________________________________
Notified Parent/Guardian Who/When: ______________________________________
Notified Church Official Who/When:______________________________________
Notified Authorities Who/When: ______________________________________
Other ________________________________________________
Witnesses to Incident:
Name:_____________________________________________________________________
Address:___________________________________________________________________
Telephone:_________________________________________________________________
Email:_____________________________________________________________________
Name:_____________________________________________________________________
Address:___________________________________________________________________
Telephone:_________________________________________________________________
Email:_____________________________________________________________________
