Incident/Accident Report
Report Type
*
Incident
Accident
Near Miss
Safeguarding concern/disclosure/issue
Is anyone in immediate danger - if Yes, STOP and call 999
*
Yes
No
Date (if known)
-
Month
-
Day
Year
Date Picker Icon
Time (if known)
Hour Minutes
AM
PM
AM/PM Option
Staff/Volunteer Completing Form
*
First Name
Last Name
Staff/Volunteer completing form Tel No.
*
Please enter a valid phone number.
Format: 00000000000.
Staff/Volunteer completing form Email
example@example.com
Incident/Accident Location
*
Allotment
Polytunnels
Offsite - Larking About
Offsite - Special Branch
Cafe
None of the above
If Incident/Accident happened offsite, please detail the following: Location Address & Full contact details of people involved
Name/s of people involved in incident/accident
*
First Name
Last Name
Name/s of other people involved in the incident/accident
First Name
Last Name
Name/s of other people involved in the incident/accident
First Name
Last Name
Description of Incident/accident
Action Taken / Treatment Administered
Follow Up Action (if applicable)
Names and contact details of witnesses (if required)
People to contact post incident/accident
Parent/Carer
Social Worker
Police
CEO
HCC (report concern)
Other
Notes from Follow Up (if applicable)
Incident Status
Please Select
Open
Closed
Submit
Should be Empty: