PUBLIC INCIDENCE REPORT
Ministry of Education, Youth and Information
School and Official Info:
Data of incident: *
MM
/
DD
/
YYYY
Time of incident: *
Time
:
Name of School: *
Your answer
Location(Address):
Your answer
Name of Reporter (Optional):
Your answer
Contact no (Optional): *
Your answer
Description, background, circumstances and relevant information leading up to the incident, and whether the incident was witnessed:
Your answer
Injury Sustained
Was any injury sustained as a result of this incident?
If yes, was medical attention sought?
Was there any property damage as a result of this incident?
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