Report an IncidentPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please report any incidents or accidents on congregational property or at off-site congregational activities. 1. Who is reporting the incident?Your name *FirstLastYour phone *Your email address 2. What happened?When did it happen? *Where did it happen? *Briefly describe the incident * 3. Who was involved?Who was directly involved in the incident? *Were any vulnerable people involved? (e.g., Child, elderly, wheelchair-bound, etc.) *YesNoWho were the vulnerable people involved? For children, please indicate ages.Who are the parents or guardians and how were they informed?Did anyone else witness the incident? If so, who?Who was responsible for the group at the time of the incident? Please include their name and contact info.Is there anyone who needs to be informed who has not yet been contacted? 4. What happened as a result of the incident?What were the specific injuries? *What emergency (medical or pastoral) care was given? Who provided aid? *What was the injured person doing when the incident occurred? Include any unsafe conditions or conduct. * Include incident? the 5. What should happen now?Is the site or premises still safe to use? If not, what action needs to be taken?Is there any defective equipment involved which requires repair or removal?What action could be taken to prevent a re-occurrence of the incident?Is there anything else you would like to say or explain?Submit
