Incident Report Form, or concern for a Child or Vulnerable Person

Incidents & Caring for others

Thank you for visiting the Reporting form.

This is to assist us on record keeping, and taking action on any safety matter that should be brought to our attention.

IN A SPECIFIC INCIDENT:

1) Have it raised to a Team Leader

2) Record it here

2) Escalate it to Pastoral Team & Operations Manager immediately in serious cases.

(Where required Ambulance/Emergency Services etc are to be involved first, and the report will be completed once the acute need has subsided)

IN CASE OF GENERAL SAFETY / NEED FOR CARE CONCERN:

Please complete the below to the best of your ability, and an investigation will take place.

When completing, the emphasis must be on Facts, Observations that were available and avoid speculation.

This form should be used for the following rare events.

- Injuries and medical incidents (Slips, Cuts, Allergic Reaction etc)

- Damage to property (TV Damaged, Wall Damage etc)

- Other incidents of Safety concern (Incidents of Hazards in Church, Suspected concern for a Vulnerable person etc)

Thank you for taking the time to complete this (Approximately 5-10 minutes)

Please remember, safety incidents should be raised with your direct leader before and in addition to completing this form.

- The CPE Leadership team.

Description of Incident

Nature of incident (Provide description of the incident in detail explaining 'Who, What, Where, When, Why, How?'. A Narrative form is helpful. *

Specific action taken - Please provide as much detail as possible (eg. First aid given to person, Hazard removed from area etc) *

Name & Contact Numbers of Witnesses to incident *

Person(s) involved

First Name *

Last Name *

Mobile Number *

Home Address *

Suburb *

Date of Birth (if known)

Details of Incident

Person preparing the Report *

Date of Incident *

Time of Incident (include AM/PM) *

Leadership member the issue was Escalated to (I.e. Pastor Iggy) *