Society 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 to be processed.

Report Form

Society Name:

Society Email:

Nature of Incident:


Near miss

Date and Time of Incident:

Name, Address, & Email of Person:


Description of Incident:

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


No action

First aid

Taken to hospital

Ambulance called

Advised to see doctor

Taken home