Volunteer Incident Report Form Link to printable form Purpose: The Incident Report Form is used to track every occurrence of an incident, or an occurrence of an accident.Definition: “Incident” is a circumstance serious enough to require immediate attention to a client, volunteer, or staff member. Incidents can occur because of a client, volunteer, or staff member’s actions, or instead in the presence of a client, volunteer, or staff member. This can include breaking boundaries or rules, failing to follow instructions, accidents, near-accidents or any occurrence that is problematic. Date of Incident* Time of Incident* Location of Incident* Person(s) Involved: (including witnesses)* Summary of Incident* Action Taken* To whom the incident was reported (police, 911, CPS, Board Member, Garden Coordinator, etc) If injured, did the person(s) involved choose to seek medical attention at a medical facility?*YesNo If yes, where did client go for medical attention?* Is follow-up action needed?*YesNo if yes, what action is needed?* Reporting Party Signature* close Reporting Party Signature Date signed*Date signed Email* Witness Signature close Witness Signature Date signedDate signed Email*Email Witness Signature close Witness Signature Date signedDate signed EmailEmail Witness Signature close Witness Signature Date signedDate signed EmailEmail
