INCIDENT REPORT
Date of Incident: August 15, 2024
Time of Incident: 1:00 PM – 1:30 PM
Location: Green Fields Integrated School of Laguna Inc.
Reported by: JEFFREY DE BELEN/ SHS Teacher
Incident Type: Injury
Description of Incident:
On August 15, 2024, at approximately between 1:00 PM – 1:30 PM, while having their Performance
Task in Physical Education 1 “Warm-up Exercise”, Mr. Lijauco a grade 11 student of ABM Cepheus got
injured on his right knee.
Individuals Involved:
Name: LIJAUCO, Gabriel Joaquin L.
Role/Position: Grade 11 Student (ABM Cepheus)
Contact Information: N/A
Injury/Impact: Knee Injury
Action Taken:
First aid was provided to Mr. Lijauco by some staffs and teacher of GFIS. Mr. Lijauco was taken to the
nearest hospital for further medical attention.
Report Filed By:
Name: Mr. Jeffrey De Belen
Position: SHS Teacher
Date: August 15, 2024