Free Incident Report Template 34Free Incident Report Template 34Free Incident Report Template 34
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Confidential Equality Related Incident Report
(Please see Guidance on page 2 for how and when to use this form.)

Name of setting
Details of incident
Date
Time
Place
Description of incident

Initial response to incident

Ideas for long term actions

Initially dealt with by
Signed
Print name
Date
Incident witnessed by
Signed
Print name
Date
Signed
Print name
Date
Signed by ENCO/Manager
Print name
Date

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Page 2 of 3

Guidance for completing this form
What is this form for?
This is a template to record equality related incidents. It has been produced
following requests from staff attending ‘Role of the ENCO’ and ‘Developing Equality’
courses. If you already have a process for recording this kind of incident you do not
need to complete this form as well.
When to use this form
This form should be used to record incidents that relate to equality issues. Incidents
should be recorded as soon as possible after they have happened.
Who should use it?
Any member of staff who witnesse