Incident Form
To be completed in the event of any major/minor incident, missing pupil, bomb threat, lock down and for reporting all incidents that are not classed as pupil/non pupil accidents, incidents of sickness e.g. scarlet fever, mumps, etc. Please complete with as much detail as possible, if not applicable please say so.
NAME OF SCHOOL *
Your answer
Date of Incident *
MM
/
DD
/
YYYY
Date Incident actually recorded *
Your answer
Time of Incident *
Time
:
Name of person reporting the incident (include contact details) *
Your answer
Member of staff recording the incident *
Your answer
Name(s) of person(s) causing the incident *
Your answer
Status (parent/carer/visitor/trespasser) *
Names of any witnesses and their status *
Your answer
Full description of incident (name of persons involved, location, nature of any injuries, attendance of emergency services, action of others, etc.) Please keep the record as factual as possible and avoid subjectivity *
Your answer
Linked incidences (if any) *
Your answer
Initial action/outcome (e.g. Informal conciliation, meeting, police intervention, warning or banning letter issues) *
Your answer
Summary of subsequent actions taken by the school, including risk assessments *
Your answer
Has the incident (other than via this form ) been reported either by telephone or email to Hamwic Central Services? *
Was anyone hurt in the incident ? If so please give details below (if no one was hurt please just put N/A) *
Your answer
If a person/persons were hurt, have you completed an accident form? If not at this stage please do so. *
What has been done to rectify the situation,repair the damage etc? Please add in as much detail. *
Your answer
Any other comments?
Your answer
signed (by typing name this assumes signature)
Your answer
Date
Your answer
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