Wild Child & CO Team Members & Contractors are to use this form to record any incidents that occur
Click the button below to 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
Yes
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