Sample Incident Report Form - Child Safe Standards

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INCIDENT/ACCIDENT REPORT FORM – sample
<Name of Faith Community Organisation>
SECTION A – The Details
DATE (of report)
WRITTEN BY
Date of incident:
PERSON(s) INVOLVED
Personnel informed:
Senior Ministry Leader
Ministry Coordinator
Pastoral Care Leader
Safe Child Safe Standards Representative
Safeguarding Officer
Other
Type of Incident
injury
behaviour
disclosure*
property damage
environment/safety
other
(specify)
*NB: If disclosure of abuse – please also complete the Risk of Significant Harm and
Reporting Concerns Forms
SECTION B – The Incident
DETAILS OF INCIDENT
Standard 5

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