Critical Incident Report Form

Incidents and hazards are not limited to, but could include:

missing students
severe verbal or psychological aggression
death, serious injury or any threat of these
natural disaster
issues such as domestic violence, sexual assault, drug or alcohol abuse
any non-life threatening event that could still qualify as a critical incident

Name of person completing form

Position of this person

Contact Phone No.

Date of Critical Incident

Time of Critical Incident

Details of persons involved in the incident:

Name

Position

Name

Position

Name

Position

Name

Position

Description of incident and background (relevant information leading up to the incident, circumstances, whether the incident was witnessed and other relevant issues).

Who was informed of the incident, including contact details (Manager, Police, Fire Brigade)?

Actions taken to date (including date and time of contact with Manager, when other agencies were informed, as well as details of support provided).

Follow up action planned