Accident/Incident Report Forms All accident/incidents must be reported ASAP up to a maximum of 48 hours from the time it occurred. Accident/Incident Report FormACCIDENT: An unplanned event that results in, or could result in, injury, illness, or damage. INCIDENT: An unplanned event that causes disruption, damage, or a near miss, but does not necessarily result in injury.Date MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Person 1 Involved(Required) First Last Person 2 Involved First Last Person 3 Involved First Last Witness 1(Required) First Last Witnessed First Hand?(Required) Yes No Witness 2 First Last Witnessed First Hand? Yes No Accident or Incident(Required) Accident Incident How did the accident occur?(Required)Witness/Witnesses description of accidentDetails of injury?(Required)Details of treatment provided for injury?(Required)Further comments in relation to the injury?Was the parent/guardian notified of the accident?(Required) Yes No Why was parent/guardian not notified of the accident?(Required)Consent(Required) I confirm that the information that I have provided is an honest and fair assessment of the accident that occurred.Description of the Incident?(Required)Actions taken following the Incident?(Required)Further comments in relation to the Incident?Was the parent/guardian notified of the Incident?(Required) Yes No Why was parent/guardian not notified of the accident?(Required)Consent(Required) I confirm that the information that I have provided is an honest and fair assessment of the accident that occurred.
