Report an Accident or Incident for Children or YouthPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.This form is to be completed by Children’s RE Volunteer or COA/Youth Advisor regarding accidents or injuries to children or youth involved in congregational activities at, or away from, First Unitarian Congregation of Toronto.Who is reporting the incident?Name *FirstLastPhone *Positions *Nursery AttendantRE VolunteerCOA/Youth AdvisorWho was responsible for the group at the time of the incident, if different from above? *Please include their name and phone.Who was injured?Name *FirstLastAge *Name(s) of Parents/Guardians *About the Parents/Guardians *They are members of FirstUThey are regular attendees, but maybe not membersThey are new visitorsHow were the Parents/Guardians informed of the incident? *Please indicate who informed them, when and how (in person, phone, through others, etc.)Who witnessed the incident?Witness name and phone *Use the "+" icon to add lines for more witnesses. What happened? the Who taken When did it happen? *DateTimeWhere did it happen? *What was the injured person doing when the incident occurred? Include any unsafe conditions or conduct. *What were the specific injuries? *What first aid, emergency or medical care was given? Include the name of the caregiver:. *What should happen now?Is the site or premises still safe for your group to use? If not, what action needs to be taken?Is there any defective equipment involved which requires repair or removal?What action can be taken to prevent a re-occurrence of the incident?Is there anyone who needs to be informed who has not yet been contacted?Who was in charge of group at the time of the accident/incident?Your nameYour Signature Clear SignatureSignature of Director of Lifespan Religious Education Clear SignatureSubmit