EE Incident Report Form
Use this form to report accidents, injuries, medical situations, or behavior incidents that occur on the EE campus or in connection with EE sponsored events. If possible, the report should be completed within 24 hours of the incident.
NAME of person submitting form: *
Your answer
TYPE of Incident: *
DATE of Incident: *
Your answer
NAMES of individuals involved in the Incident: *
Your answer
Please DESCRIBE the incident in detail: *
Your answer
Names of WITNESSES: *
If this is a Behavior or Safety Incident, please list any witnesses who may have seen the incident when it occurred.
Your answer
Please describe any known INJURIES: *
Your answer
Please describe any ACTIONS taken by EE volunteers, staff or bystanders. *
Your answer
Has EE Administration been NOTIFIED of the incident? *
Comments
Please include any additional information you would like to provide regarding this incident.
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