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Incident Report Form
This report should be completed as soon as possible after receiving information about the incident.
Date of report
DD slash MM slash YYYY
Your details
Name
First
Last
Mobile
Email
What is your role?
Host
Guardian Care Manager
Trip staff
Trip First Aider
Other
What is your role?
Address
Street Address
Address Line 2
City
Zip/ Postal Code
Student details
Name
Age
School
Mobile
Incident details
It is important you include as much detail as possible
Where did the incident take place?
when staying with an AF host
when on an AF trip
other
Which trip?
Address
Street Address
Address Line 2
City
Zip/ Postal Code
Responsible adult - host, trip leader etc
First
Last
Responsible adult's mobile
When did it happen? Date
DD slash MM slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
What happened?
How did the student behave?
Detail any relevant information that happened before the incident
Has the student been asked what happened?
Yes
No
Exactly how did they describe the incident in their own words?
What clarification questions did they ask?
Why not and when will they be asked what happened?
Actions Taken
Summary of actions taken
Details of follow up discussions
External agencies including emergency services
First
Last
Date
DD slash MM slash YYYY
Details
Student's parents
First
Last
Date
MM slash DD slash YYYY
Details
Student's host
First
Last
Date
DD slash MM slash YYYY
Details
Student's school
First
Date
DD slash MM slash YYYY
Details
Other Information
What else should we know?
Comments
This field is for validation purposes and should be left unchanged.
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