Date

Date of Incident

YYYY

Time

Time of Incident. Estimate if unsure.

Hour

Minute

Second

Name

Name of staff member reporting the incident.

First Name

Last Name

Parties involved

Include the names of staff members, athletes, witnesses, etc, involved in the situation.

Describe the situation

Describe the situation in as much detail as possible. Include information on what happened, how it happened, etc.

Staff Action

Describe all actions taken by staff in the situation (First Aid, Emergency Services, etc)

Follow-Up Plan

Outline the follow-up plan for staff with the parties involved (Email, phone call, message, etc)

Other Details

Include other details you feel may be important to be aware of.

Incident Report Form

Location