OFF SITE ACCIDENT INCIDENT REPORT

OFF SITE ACCIDENT INCIDENT REPORT

All Accidents/Incidents that happen off school campus must be recorded using this form, submissions will automatically go to the administrators
Your Name*
First Last
Email*
Mobile Number
Date of incident*
MM slash DD slash YYYY
Time of Incident*

: Hours

Minutes
Child's Name*
First Last
Child's Grade
The Incident
Description of the incident:
Location of the incident
Person(s) involved in the incident:
Witnesses to the incident:
Immediate action in responding to the incident:*
First Aid treatment given:
Person at QAIS contacted?
Parent Notification
Who notified parents?
Which QAIS staff person notified the student's parents of the incident?
What time were parents notified?

: Hours

Minutes
Which medical facility was the child brought to (If Applicable)?
Who accompanied the child to the Medical Facility?

The Incident