check

Incident Form

Wild Child & CO Team Members & Contractors are to use this form to record any incidents that occur 

Click the button below to start.

Start

Question 1 of 11

This Incident Report is completed by (include your full name and contact details including email & phone number): 

Question 2 of 11

Describe the incident that occurred (remember to describe the facts of the incidents not your opinions)

Question 3 of 11

Record the location the incident occurred, as well as the date & time.

Question 4 of 11

Persons affected by the incident 

Question 5 of 11

Cause of the incident 

Question 6 of 11

Record any injuries including the person injured, how/where they were injured. Include the contact details including name phone number and email of the person injured. 

Question 7 of 11

If injured, what medical aid was provide? And by who?

Question 8 of 11

Name & contact details of any witness (including phone number & email address)

Question 9 of 11

Would you consider this a serious incident 

A

Yes

B

No

Question 10 of 11

Was any additional investigation carried out and/or was the incident reported to any body or agency (e.g NDIS, Centre service being held in , Real Estate)

Question 11 of 11

Have any steps been taken or suggestions made to reduce or avoid the same indictment from occurring again

Confirm and Submit