First Aid, Accident & Incident Report Log
This form should be filled out and submitted within 8 hours of the event occurring.
Accidents & First Aid Reporting
An accident is an event that caused/may have caused harm: medical care was provided, OR there is potential for medical care being provided in the future due to the accident. If any medical care was provided (cleaning a scratch, administering a band-aid, etc.), fill out the form in regard to an accident. As a reminder, CTHF staff and volunteers to not have permission to administer medications (prescribed or over the counter) to participants.
Incident Reporting
An incident is a broad event that can include things like behavior challenges, bullying, suspected abuse/neglect, and conversations that go against camp rules (sex, drugs, violence, etc.).
Your Name
*
First Name
Last Name
Your Phone Number
*
Required in case we need to follow up with you for more information.
Location of the Accident/Incident
*
Include the general location and the room (if applicable), for example: Los Duranes Community Center, gym
Report Type (see description above to determine type)
*
Incident
Accident
Time of the Accident/Incident
*
Hour Minutes
AM
PM
AM/PM Option
Date of Accident/Incident
*
-
Month
-
Day
Year
Date Picker Icon
Name of Primary Participant Involved in the Accident/Incident
*
First Name
Last Name
If there are any secondary participants involved in the accident/incident, please list them here. Depending on the accident/incident, a separate report may be requested for any secondary involvement.
Please include first and last names. If unknown, please ask other volunteers/staff before submitting. If someone was just a witness and not directly involved, submit their info toward the end of the form.
Description of Incident
*
Please be very detailed and objective. Do not include opinions, only include factual information that was witnessed by other staff/volunteers/participants. If an injury occurred, be specific about the injury: instead of saying "injured knee," say "left knee has an abrasion about one inch long and a half inch wide, blood present." If cause of an injury is known, note that as well. If unsure, note that the cause is unknown.
Action Taken
*
Please be very detailed. If medical care was provided, describe what was provided, who provided the care, etc. If conversations were had about behavior expectations, consequences, additional follow-up, etc., please describe conversations in detail. Use names wherever possible instead of "he/she/they" descriptors. If care of the situation (medical or otherwise) was deferred to a guardian, or if care was referred to professionals outside of the program, please note that here.
Photo of Accident/Incident Area
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Photo of Injury/Other Upload
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Witnesses (do not include minors)
First Name
Last Name
Witnesses (do not include minors)
First Name
Last Name
Additional Notes
If you have additional context you wish to include, or additional witnesses to list, please use this space for any overflow information you feel is relevant.
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