School Incident Report Form
A School incident report form is a form which is used to provide complete details of the incident that might have taken place inside the school premises. The incident for which the form has been prepared can be of various different types. These forms can also be used to make claim from the insurance company.
Sample School Incident Report Form
General Information of School
Name of School______________ Name of Principal____________
Address___________ City/State__________ Zip____________
Phone_________ Email_________ Fax_______
Incident Report Information
Date of Incident___/___/___ Time/Hours__________
Place of Incident_____________
Nature of Incident____________ Major Cause of Incident______________
Description of Incident______________
Witnesses of Incident________________ Time when they witnessed it___________
Name and Addresses of Witnesses___________________
When the incident reported to the in charge/administrator: Date/Time_______
Damage it Caused_______________
Any Police Complaint_____________
Person/s Involved in Incident___________ Name/s______________ Address_______
Anyone Injured, if yes then provide details_______________ Name and Address__________
Any medical treatment provided to injured people___________
Name of Hospital/Physician____________ Address____________ Phone_______
Cost of injury treatment__________________
Cost of Damage____________
Receipts of Hospital_________
Total Amount for Claim____________
Report Prepared by: Name_________ Signature____________ Date of Submission____/____/___
Category: Report Forms
