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Incident/Accident Report
(including near misses and incidents of unsafe acts or conditions)
Details of person reporting the incident/accident
First Name
Last Name
Email
Mobile Number
Details of injured person
Full Name
Time of incident/accident
Date of incident/accident
Treatment of injury
Nil
First-Aid
Doctor (Not-Hospitalised)
Hospitalised
Other
How did the accident/serious harm happen?
Tip: (Please give as much details as possible)
Was a staff member/location Pastor notified?
Form completed by (Full Name):
Date person completed form
Submit
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