Incident Report - Grandview Christian Church

What Type of Incident Occured? *

Medical

Behavioral

Other

Name of Person(s) Involved in Incident *

Date of Incident *

Time of Incident *

Location Where Incident Occured *

Name of Caregiver(s) That Responded *

Caregiver Response and/or First Aid *

Medical: Describe the medical attention provided, i.e. provided band aid and neosporin, provided CPR, called 911, etc.
Behavioral: Describe the caregiver reaction, disciplinary action, and/or plan for follow up.

Parent/Guardian Contacted

Yes

No

Person Who Contacted Parent

Other Contacts or Actions

Additional Comments