Accident / Incident / First Aid Report

Details at the top of this form apply to person making the report.

NOTE: If emergency services are called, a Critical Incident Report must be completed instead. Go to critical.life.house to complete.

Your name *

Email address *

Date of Incident *

Time of Incident *

Location of Incident *

Names of those directly involved *

Names of witnesses *

Names of team leader/s present at the time *

Description of incident *

Action taken *

Is further action required? *

Who (in leadership or externally) has been notified of the incident

First Aid Treatment

Please note: no medication is to be administered to a person under 18yrs unless it is the prescribed medication of the person and consent has been given by the parent.

Only people with a current First Aid Certificate; medical doctors or registered nurses are to administer first aid in a LifeHouse ministry /program. Outside medical treatment should be sought where a suitably trained person is not available to administer first aid and in the case of an emergency, an ambulance called.

All treatment/medication given needs to be recorded on this form.

This form must be returned to the appropriate Department Leader within 24 hours of First Aid Treatment administered.

Was First Aid treatment required? *

Parent / Guardian has been notified and information passed on

Follow up required *

Keep a copy!

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