CC Incident Report

COMMUNITY CAMP INCIDENT REPORT

YOUR First Name

YOUR Last Name

Student First Name

Student Last Name

YOUR Phone Number

Date of Incident

Time of Incident

Please describe the incident with as much detail as possible, including the sequence of events that led up to the incident.

Was the student injured?

Yes

No

Please describe the injury.

Was medical attention needed?

Yes

No

If medical attention was needed, please describe.

Please provide any necessary additional information. If parents were contacted, please describe the communication here.