Confidential Incident/Accident Report

Confidential Incident/Accident Report
This confidential report is used to record details and actions taken concerning any incident that affects the health and safety of girls or volunteers during a Girl Scout activity. This could include behavioral problems, vehicle accidents, medical emergencies, property damage, physical altercations, suspected child abuse or any other out of the ordinary occurences involving Girl Scouts. This list is not all-inclusive. If you are unsure about whether a situation qualifies for an incident/accident report, contact the GSHNC Customer Care team for guidance.

If you are ever in a situation where you have to call 911 or seek assistance from law enforcement or emergency services, you will need to contact our council office immediately after emergency help has arrived and you are able to make the phone call.
- Call the main number at Girl Scouts, Hornets’ Nest Council at 704-731-6500.
- If it is after normal business hours, follow the prompts for emergency procedures.
- If there is a life-threatening situation, please let the person who answers know that this is a “Code Daisy” situation.
Please note, in the case of a vehicle accident, vehicle insurance is the responsibility of the vehicle owner. Neither Girl Scouts, Hornets' Nest Council or Girl Scouts of the USA is responsible for vehicle damage.
Contact Information of Individual Filling Out Report
Name*

First NameLast Name
Position (Troop Leader, etc.)*
Email*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address 2

CityState

Zip Code
Information about Incident
Zip Code where the incident occurred?*
Date of Incident: *

MonthDayYear
Date
Time of Incident:*

:HourMinutesAM/PM Option
Names and Contact Information for all individuals involved: *
Names and Contact Information for Other Witnesses (if applicable):
Description of Incident: (Describe location, activity, sequence of events and emergency actions taken.) *
Attach any supporting documents, police reports, diagrams, photos, etc.

Browse Files

Cancelof
Was treatment at a medical facility necessary?*

YesNo
Name and location of medical facility:
Were parents of girls notified of the incident?*

YesNo
How were parents notified?

PhoneEmailIn PersonOther
Name and Position of person who notified parents:
Additional Comments about Incident:
Signature
Should be Empty:

Confidential Incident/Accident Report

Contact Information of Individual Filling Out Report

Information about Incident