Form Entry

This incident report should be completed as soon as possible after the incident occurs and should include as detailed a description of the situation as possible.

First Name

Last Name

Mobile Phone

Gender

Male Female

Student Name(s)

Phone Number

Address

Nature of Injury/Incident

Date and Time of Incident

Campuses

West Faro de Luz Southwest Edmonton Arabic Alliance Church Bonnie Doon

Where inside the building did the incident occur?

All Leaders Present:

What happened?

Why did it happen?

What action was taken?

Were the parents contacted?

What was the parents' response?

Name of person completing this report

Witness Name

We will follow up for signatures and next steps.

Submit

Youth Incident Report

Form Entry

West Campus

Southwest Campus

BONNIE DOON CAMPUS

Faro De Luz