Incident Report Form

By completing this form, you acknowledge that it is a true and accurate account of events surrounding the incident.

A first aider should take care to fully document all incidents where a casualty requests advice or first aid is administered. This can be recorded in a first aid record book and/or the accident register. No matter how small the treatment, the first aider has a responsibility to record all treatments given. An accident report may also be required to enable investigation of the cause of an accident. Advice should be sought from your churchwardens as to the procedures to be followed in your church.

First Aider / Leader's Full Name

First Aider / Leader's Address

Date of Injury

Time of Incident

Full Name of Child

Date of Birth of Child

Sex

Male

Female

Injury/Illness/Accident Details

Description of injury/illness/accident

How and where did the accident/injury occur?

Equipment/tools involved

First Aid Assessment and Observations

Signs/symptoms/history

General observations

First aid treatment/management

People Informed

Parent/Guardian, Leader advised of the incident

Yes

Name of Parent/Guardian Notified

Date of Notification

Time of Notification