Community of Faith - Incident Report

Volunteer/Congregant Name (involved in the incident)

Your Name

Volunteer/Congregant Contact Information:

Your Email

Where did the incident happen?

Date and time of the incident

Description of Incident (provide as much detail as possible , including sequence of events that led up to the incident)

Was the Volunteer/Congregant injured?
Yes
No

Describe Injury:

Was Medical Attention Needed?
Yes
No

Any additional information needed?