Free Incident Report Template 24Free Incident Report Template 24Free Incident Report Template 24
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Updated 10/11/16

Harrison Public Schools
Incident Report Form
This form is to be used for all incidents other than HIB or EVVRS

LS___ HS___WMS___HHS___ INCIDENT REPORT
DATE & TIME OF INCIDENT _________
DOES THIS INCIDENT INVOLVE:

Students? Y

LOCATION
N

Staff? Y

_________

N

Other(s)? Y

NAME OF PERSON(S) INVOLVED:

N
_________
_________

Address ______

_

Phone

__

DESCRIPTION OF INCIDENT (Please include names of individuals involved, the nature of the incident,
and a brief narrative of what occurred):

_____________________________________________________________________
_____________________________________________________________________
________________________________________________
_____________________________________________________________________
____________
_____________________________________________________________________
____________
WAS ILLNESS OR INJURY INVOLVED? (If yes, provide details and attach copy of accident report.)

________________________________