Online Incident Report Form

To be used by SSWA officials to provide details of Critical Incidents at SSWA events.

Name*
Name of Person completing the form
First Last
Phone*
Contact mobile number
Email*
Please provide your email address
Date*
Please list date and time of incident
Time of incident

Hours :

Minutes

AM/PM
Location
Please indicate the location of the incident
Description
Please provide a description of the incident including the names of students and staff involved.
Action
Please indicate what action was taken including any medical attention administered.
Parent Contact
Were parents or guardians contacted?
- Yes
- No
Witness
Please provide name and contact numbers of any witnesses?

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