Incident Report

Type of Incident* This field is required.

Incident Report

Employee Injury Report

Property Damage Report

Security Incident Report

Reported By* This field is required.

First Name

Last Name

Date and Time of Incident* This field is required.

Location of Incident* This field is required.

What is your location?* This field is required.please add an exact address as well as title.

Ministry/Department Involved* This field is required.

Legacy Youth

Young Adults

Hills Kids

Worship

Production

Facilities

Safety

Outreach

HWH

Parking

Summit

Ushers

First Impressions

Other

Type of Incident* This field is required.

Provide a detailed timeline of the event(s) and include the extent of injury, if any. * This field is required.

File Uploadattach any photos, videos, or documents pertaining to this incident.

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Select files to upload

Max. file size: 10.6MB

Browse Files

How many people were involved?* This field is required.

If multiple, list names and ages of all parties here:* This field is required.

Who was Involved?* This field is required.

Individual's Full Name* This field is required.

First Name

Last Name

Membership Status* This field is required.

Regular Attendee

Visitor

Staff

Volunteer

Other

Date of Birth

Date

Emergency Contact

Full Name

Relationship

Phone Number

Witnesses* This field is required.

Parent or Guardian Name

First Name

Last Name

Parent/Guardian SignatureIf no parent or guardian is available at this time, please follow up with them regarding this incident ASAP.

Was an emergency response team notified?* This field is required.Police, Ambulance, Fire, Social Services, ETC.

YESNO

Was First Aid provided?

YESNO

Was an ambulance called?

YESNO

Was patient transported to the hospital?

YESNO

Was a police report filed?

YESNO

Was a Child Protective Services report filed?

YESNO

Is follow-up needed?* This field is required.

YESNO

Pastoral Care Needed?

YESNO

What type of follow up is needed?This could be prayer, care, further documentation, or something else.

Injured Employee's Name* This field is required.

First Name

Last Name

Employee Job Title

Supervisor's Name

First Name

Last Name

Was the Supervisor informed?* This field is required.

YESNO

Date and Time of Incident* This field is required.

Witnesses

Location of Incident* This field is required.

Explain what happened* This field is required.

Could anything have been done to prevent this? Please explain.

Body Parts Affected* This field is required.

Arms/Hands

Legs/Feet

Head/Neck

Shoulders

Torso/midsection

Back/Spine

Have you had prior injuries to the affected area?

YESNO

Was a Doctor Consulted?

YESNO

Upload any photos, videos or documents relevent to this injury.

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Select files to upload

Max. file size: 10.6MB

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Employee Signature

What property was damaged?* This field is required.Please be specific. If this is a vehicle or piece of technology, list year/make/model.

Please describe the damages:* This field is required.

Describe what happened/how these damages occured:* This field is required.

Upload all files pertaining to this incident. * This field is required.photos of damages, insurance cards, licenses, video of incident, etc.

Drag and drop files here

Select files to upload

Max. file size: 93.1TB

Browse Files

Is this property owned by 7 Hills Church?* This field is required.

YESNO

Owner's information* This field is required.

Full Name

Please enter your phone

Please enter your email

Is this an emergency?* This field is required.

YESNO

Type of Security Incident* This field is required.

Theft

Suspicious Activity

Graffiti

Vandalism/Destruction of Property

Piggybacking/Tailgating

Person inside with no visitor badge

Lost & Found

Intruder

Homeless Encampment

Hostile Encounter

Unattended Package

Other

If Other, please explain:* This field is required.

Were authorities notified?* This field is required.

YESNO

Detailed description of incident:* This field is required.

Are you the primary contact for this incident?* This field is required.

YESNO

Primary contact information* This field is required.

Full Name

Please enter your phone

Please enter your email