incident report

where possibilities are limitless

At No Limitts we care and are committed to both yours and our client's lives!

So please let us know about whatever is going on out there in the community and our client's day to day to life

Request Support

Incident Report Form

Date of Incident

Time of Incident

Other:

CALL YOUR PROGRAM FACILITATOR IMMEDIATELY

Who was involved?

Person 1

Person 2

Person 3

Person 4

Phone

What happened?

Describe briefly: What happened? How the incident was identified? Possible cause? Impact to people involved? Who (if any) were harmed? What was the extent of the harm?

Supporting evidence

Please upload any supporting evidence that may be useful. This may include photos or documents. All materials will be kept confidential inline with our Privacy policy and only used for internal review when investigating the incident

Upload File

Immediate actions taken

(Include details of actions taken to ensure the health, safety and wellbeing of the individuals affected by the incident; e.g. first aid; reported to police; ambulance called; emotional support; meeting participant's needs; etc.)

Confirmation of completing employee

I hereby confirm that the information provided in this report is accurate to the best of my knowledge:

Your Signature

Select a date

Thanks for submitting!