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Accident / Injury - Student Report / CRPS
This accident / injury report form is for students only. All other accidents for staff or volunteers need to be reported through the WORKS program. Please ensure that your Principal / Acting Principal / Supervisor has been notified. If your answer is no you are required to forward the emailed version of this form to your administration.

The information gathered within this form is considered private and confidential and shall only be used for the purposes which it is collected for.
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Email *
Date *
MM
/
DD
/
YYYY
Time *
Time
:
Which school / Location of accident - incident *
Required
Who is filling out this report *
Required
First and last name of person filling out this report *
First and last name of injured person *
Which grade *
Location *
Required
Staff member or witnesses of the accident / incident *
What happened *
Required
Description of accident / incident *
What's injured *
Required
Type of injury *
Required
Action taken *
Required
Type of first aid given *
Required
Principal / Acting Principal / Supervisor has been notified. If your answer is no you are required to forward the emailed version of this form to your administration. *
Parents/Guardians have been notified. *
Required
Additional information
Corrective actions / Recommendations *
A copy of your responses will be emailed to the address you provided.
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