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Incident Report
Highview Community Church Protection Policy Incident Report Form

Incident Form should be completed as soon as possible after the incident and should include as detailed a description of the incident as possible.
Student Name(s) *
Your answer
Phone Number *
Your answer
Address
Your answer
Describe the incident *
Your answer
Incident Date *
Your answer
Incident Time *
Your answer
Incident Location *
Your answer
Leaders Present *
Your answer
What Happened? *
Your answer
Why Did it Happen? *
Your answer
What Action Was Taken? *
Your answer
Were Parents Contacted? *
Parent Response *
Your answer
Leader's Name (type) + Signature *
Your answer
Witness Name (Type) + Signature *
Your answer
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