Incident/Injury Report

Complete this form as soon as possible after any incident or injury. Stick to facts — leave out opinions or assumptions.

Section 1 of 2 — About this report

Email *

Enter a valid email address.

Name and role of person completing this form *

This field is required.

Were police, fire, or EMS called for this event? *

Yes No

Select an option.

Was this an incident or an injury? *

Incident Injury

Select an option.

Section 2 of 2 — Incident details

Incident

Please list the names and roles of the people involved *

This field is required.

Describe the incident — keep it to facts, no opinions or assumptions *

This field is required.

Were parent/guardian notified? If yes, include who spoke to whom and day/time *

This field is required.

What follow-up is needed? *

This field is required.

Section 2 of 2 — Injury details

Injury

Please enter the name and role of the person injured *

This field is required.

Describe how the injury took place — please refrain from including opinions or assumptions *

This field is required.

Who contacted the parent/guardian, and when? *

This field is required.

What follow-up is needed? *

This field is required.

✓

Report submitted

Thanks — this has been logged. Reach out to your supervisor if immediate follow-up is needed.

This form was created inside of Refresh Collective.