Incident Report Form Instructions

This form should be completed as soon as possible after any significant incident requiring formal documentation. Complete all sections thoroughly and objectively, focusing on factual information.

Important: For safeguarding concerns, also complete the school's Safeguarding Concern Form and notify the Designated Safeguarding Lead immediately.

Incident Report Form

Incident Details

Date of Incident:

Time of Incident:

Location of Incident:

Type of Incident:

If 'Other', please specify:

Severity Level:

Individuals Involved

Students Directly Involved:

Student Witnesses:

Staff Members Involved or Present:

Other Individuals Involved:

Incident Description

Factual Description of What Occurred:

Events Leading Up to the Incident:

Possible Contributing Factors:

Immediate Response

Immediate Actions Taken:

First Aid or Medical Attention Provided:

Was external emergency assistance required?

Yes

If 'Yes', please provide details:

Follow-up Actions

Follow-up Actions Taken or Planned:

Staff Responsibilities for Follow-up:

Timeline for Follow-up:

Additional Information

Additional Relevant Information:

Supporting Documents:

Report Completion

Report Completed By:

Position:

Date Completed:

Signature:

_______________________________

Review and Verification

Report Reviewed By:

Position:

Date Reviewed:

Signature:

_______________________________

For safeguarding concerns, this form must be submitted to the Designated Safeguarding Lead immediately upon completion.