Incident Report

Complete as soon as possible. Record only facts. Notify your supervisor straight away.

Participant name *

Completed by *

Date of incident *

Time of incident *

Date you became aware *

Time you became aware *

Location *

Who was involved / any witnesses? *

What happened? (facts only — what led up to it, what occurred) *

Any injury or harm? *

First aid / medical attention given? *

Yes

Not applicable

Actions taken (immediate response) *

Who was notified, and when? (supervisor / manager, family or guardian, emergency services) *