Incident Report
| Example
Church Incident Report |
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| Date of Incident: | Time of Day: | Person Reporting:
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| Who was involved in the incident? Please list all involved persons: | ||||
| What were the details of the incident: |
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| Where did the incident happen? |
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| What do you believe caused the incident? |
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| Could this incident have been avoided? | Yes □ No □
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| If Yes, please explain: |
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| Was a child involved in the
incident? |
Yes □ No □ |
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| If yes, was parent notified? | Yes □ No □
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| Insurance company notified? | Yes □ No □ n/a □
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| Phone number of person reporting incident: | ||||
| Signature of person reporting incident: | ||||
| Person responsible for follow-up: | ||||
| CC: Business Administrator File
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