Incident Report

Document ID

INCIDENT1

Title

Incident Report

Print Date

05/17/23

Revision

1.1

Prepared By

EC Leadership Circle

Date Prepared

05/17/23

Effective Date

05/17/23

Reviewed By 

EC Leadership Circle

Date Reviewed

05/17/23

Approved By

EC Leadership Circle

Date Approved

05/17/23

Link to Google Doc Template

Process:

  1. Once the situation is non-emergent, a witness should make a copy of this form on the drive, and complete the report.
  2. An adult witness should complete this form. If there was no adult witness, an adult should complete this form using direct quotes from a student witness whenever possible.
  3. Share the Incident Report with the Leader on Duty, who will store it in a secured Google Drive folder

Milestone Democratic School

Incident Report

Date

Time

Students Involved

Witnesses

Person Completing Form

What happened from witness perspective?

Actions Taken (mark any/all actions taken):

Parent / Guardian Notified

Date & Time:

Present on call:

Notes:

Further Medical Action Taken

Notes:

CARE Referral Made

By Whom:

Last updated bySean Anderson on May 17, 2023
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