[Church Name]
This incident report must be completed as soon as possible after an incident occurs. Please include a detailed description of the situation and have it signed by the leader(s) present at the time. A parent or guardian must sign to acknowledge that they have been informed of the situation. Once completed, please submit the report to your direct team leader.
Guest Information
- Guest Name: ________________________
- Phone Number: ______________________
- Address: ____________________________
Incident Details
- Date of Incident: ________
- Time of Incident: ________
- Location of Incident: __________________________________
Personnel Involved
- Leaders Present: __________________________________
Incident Description
Describe what happened in detail:
Actions Taken
Describe any actions taken in response to the incident:
Parent/Guardian Notification
- Were the parents/guardian contacted?
- [ ] Yes [ ] No
- Parent/Guardian Signature: __________________
- Parent/Guardian Response:
Reporting Leader Information
- Leader’s Name (Print): __________________
- Leader’s Signature: __________________
Witness (if applicable)
- Witness Name (Print): __________________
- Witness Signature: __________________
Please ensure all sections are completed accurately before submitting this report.