INCIDENT REPORTING

Teacher Name

First Name

Last Name

Student Name

First Name

Last Name

Date of Incident

MM

DD

YYYY

Location and studio where the incident happened.

Description of what happened.

Action taken.

How did you as teacher respond? For example; Was first aid required? Was there a follow up with student? Where their parents informed, etc?

Do you think we need to follow this up with an incident report. If so please download and complete attached form.

Yes

No

Do you think we need to follow up the incident with the students family?

Yes

No

Unsure