Incident Report

Contact Information of Injured Person(s)

First Name

Last Name

Phone

(###)

###

####

Address

Type of Incident

Physical

Emotional

Property Damage

Where did the incident occur? Please provide specific areas of the church or property.

Please provide as many specific details as possible i.e. dates, times, individuals involved etc

Witness Contact Information

First Name

Last Name

Phone

(###)

###

####

Witness #2

First Name

Last Name

Phone

(###)

###

####

Witness #3

First Name

Last Name

Phone

(###)

###

####

Remarks from injured individual (s)

Whom besides the Lead Pastor, Director of Administration & Congregation President should see this report?

Incident Report Submitted By:

First Name

Last Name

Position:

Date

YYYY