Incident & Accident Form V2.8
This form is to be used for ALL accidents, injuries and incidents
  • Brief description eg. fell on trampoline or tripped over
  • Please choose which category this is.

    Accident = someone hurt or injured
    Incident = someone nearly hurt, near miss, event that needs documenting(theft,evacuation,missing person,etc.)
  • / / :
  • The key person/s injured or part of the incident
  • Other key person/s injured or part of the incident Key witnesses to the incident .
  • Other key person/s injured or part of the incident Key witnesses to the incident .
  • Fill in others involved or key witnesses or helped with the event

    N/A - if not applicable
  • Detailed Description of what actually happened, give specifics.

    BE SPECIFIC & DETAILED WHERE NECESSARY
    there is no text limit
  • Actions taken following incident eg, applied bandaid.
    Who did things(eg. Camp staff gave firstaid)
    How long things took, or happened for.

    BE SPECIFIC & DETAILED WHERE NECESSARY
    There is no text limit.
  • Check Only boxes that apply
  • List group name, or Staff if a staff incident or accident
  • Identity of form-filler:

  • Phone number of the person lodging the form
  • Please choose the nearest area possible.
    If the area doesn't exist please let Alex know.
  • For adding handwritten A/I's or photos