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Incident Report

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fotegam492
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69 views2 pages

Incident Report

Uploaded by

fotegam492
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPORT

Name Date of Incident Time

Injured Student’s Address and Phone Number

School Site Location of Campus where accident occurred

Describe what happened:

Describe Injury:

School Employees or volunteers who witnessed incident:


Name Address Phone No.

Medical Response

Was medical attention needed or provided?


First Aid Given: Yes  No  Ambulance Yes  No  911 called? Yes  No 

Other Witness Contact Information


Name Address Phone No.

Follow-up (if applicable):

Teacher/Site Administrator Signature Date


FORM 314 ( OCT 2015)

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