Incident Report

Name of staff doing this report:

Site

Today's Date

Date of Event

Apx. Time of Event

Name(s) of People involved

Description of the Event

What steps were taken following the injury

Were any of the following Community First Responders a part of this event? (Check all that apply)

Animal Control

Police Dept

Fire Dept

EMT/Ambulance

Were you, another staff, or volunteer the ones to contact the first responders?

Do you believe this is handled or do you need follow up for next steps?