Incident Reporting Form

At Cornerstone we seek to maintain a safe environment for everyone to hear the good news about Jesus. Please use this form to report any incidents where someone has been injured (or nearly injured) so that we can ensure we can care for them and maintain a safe church environment.

Completed forms will be emailed to the Admin Team who oversee our health and safety policies and register.

ALL INCIDENTS SHOULD BE REPORTED WITHIN SEVEN (7) DAYS

First Name *

Last Name *

Date of Report *

Date of Incident *

Type of Incident *

Which area of church did the incident take place? *

Names and details of affected parties *

Incident / Issue description *

Action(s) taken *

Outcome(s) if known

Is this type of incident one-off or ongoing? *

One off

Ongoing

Have appropriate steps been taken to address this incident? *

Yes

If 'yes', please describe

If 'no', what needs to be done?

If an incident is a head injury it requires a follow up with a medical professional. We recommend that you take your child to be medically assessed as soon as possible. Please sign to acknowledge that we have informed you of this:

Head Injury parent/ caregiver signature