Incident Report Form
Please fill out this form if you are involved in or witness an incident as soon as it is safe to do so. Reminder: Incidents are events where someone is injured. If this is a dispute over a rule or conduct of other school, use the Dispute Resolution form instead.
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Date of Incident *
MM
/
DD
/
YYYY
Approximate time of incident *
Time
:
Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Your Role (e.g., Volunteer, delegate, FA, Captain, etc.) *
Phone Number *
Please List any Individuals Involved *
Describe the Events leading up to the Incident
Describe what Occurred During the Incident *
Describe any Outcomes, Results, or Follow-Up Actions *
Were there any Injuries Sustained? *
Describe the Injuries and treatment provided *
Submit
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