Incident Report

Incident Report

Incident Report

This form is used to report an incident.

Name of Person Reporting Incident(Required)
Name of Person Involved In Incident(Required)
Is there anything that stands out about this individual?
MM slash DD slash YYYY
Time of Incident
:
Please provide a detailed, factual account of the incident. Include what was observed, said, or disclosed. Use exact quotes when possible. Avoid personal opinions or assumptions.
Please describe immediate steps taken to protect those involved, notify staff, separate parties involved, or secure evidence.
Which staff member did you discuss this incident with?
Is there anything else you want us to know?
Signature