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Recreation and Parks Services Division - Incident Report

 

Section A: Individual

Enter individual's information. If the individual is age 16 or younger, insert parent or guardian's name and contact information in addition to child's information.

Is the individual age 16 or younger?
 

Section B: Responder

Enter responder information and the name of the person filling in this report.

Section C: Incident

Enter details about the incident. Be as specific as possible.

Did anyone witness the incident?
 

Section D: Medical

Level of Awareness
 
Airway
 
Breathing
 
General Assessment
 
Please select the area(s) of the person affected by the incident. Be as specific as possible.
 

Section E: Emergency Services

Enter details about the incident. Be as specific as possible.

Action taken
 
Was 911 contacted?
 

Section F: Report Acknowledgement

By submitting this report, you are certifying that the information contained within is correct to the best of your knowledge, are you agree that if further information becomes available you will report this information to your supervisor. The information contained within this report is of a confidential nature and should only be shared with the area coordinator, building in-charge, and/or management.