High School/Activities School Incident Report
Email address
Date of Incident
MM
/
DD
/
YYYY
Time of Incident
Time
:
Building
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Specific Location
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Name of Injured/Affected Person
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Gender of Injured/Affected Person
Grade
Phone Number
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Email Address
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Describe the Incident/Accident
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Describe Loss/Injury
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Weather Conditions (if applicable)
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Describe Medical Treatment/First Aid
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Name of Staff in Charge of Area/Classroom
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Witness(es) Name
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Witness(es) Phone Number
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Witness Description of Incident Accident
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Persons/Entities Contacted
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Suggested Corrective Action
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