Incident Report Form

Fill out this form for every accident or incident (including near misses) that happens during your society events. Your response will be emailed to [email protected] to be processed.

Society Name Society Email

Nature of Incident

Accident Near miss

Date and Time of Incident Name, Address, & Email of Person Location Description of Incident

Describe what happened, where and how. State what the injured person was doing at the time.

Outcomes

None First aid Taken to hospital Ambulance called Advised to see doctor Taken home Other, explained above in description