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Shelters PALs Shelter Liaison Reporting Shelter Status History Trainings PAL Applications PAL Status History PAL References PAL Shift Assignment Playspace Shifts PAL Shift Logins Incident Reports
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Incident Reports

Add Incident Report

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Playspace Accident/Incident Report Form
Use this form to report accidents, injuries, medical situations. All incident reports should be completed
within 24 hours of the event.
PERSON FILING REPORT
As the person filing the incident report, you must complete this section even if you were not directly involved in the incident. Please note that a member of our team may follow up with you for additional information or clarification as needed.
 *
 *
 *
 *
 *
 *
ext.
 *
Persons Involved
Please list all individuals who were directly involved in the incident.
 *




Person 1
 *
 *
 *
Person 2
Person 3
Additional Persons
Please list any additional person(s) involved in the incident in the space provided. Include first names, last names, and their role in the Playspace (i.e., PAL, Child, Parent/Guardian, etc.).
Incident Details
 *
 *
 *
 *
 *
 *
 *
Injuries/Medical Services
 *





Police Involvement
 *




Witnesses
 *


Incident Response and Follow Up
 *
 *
 *
Additional Notes (Optional)
Please use the spaces provided to discuss any relevant environmental factors (# of kids in Playspace, toys involved, etc), any prior concerns related to this situation or person(s) involved, and any recommendations for how to prevent this incident from happening again in the future.
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You've made changes to this Incident Report. Do you want to save these changes before going to the next screen?
Report Name *
Description
Reports and Charts Panel
Each table has a panel listing its reports and charts, organized in groups.
Please wait while your new report is saved...
Print the report as a table
Print one Incident Report per page ( total)
Using the form:
Print as much of the timeline as fits on a single page
Print the timeline over multiple letter-size pages in landscape orientation
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