IncidentReport form Event or Program name Name of MFC staff member or volunteer completing form Contact Email Date of incident Time of incident Were there any witnesses to the incident YesNo Location of incident Name of person/s involved in incident Contact details of person/s involved in incident Description of medical or other attention required as a result of incident Did the incident occur as a result of a risk or hazard YesNo Had the risk or hazard been identified prior to the activity commencing (if known)? YesNo What measures were used to eliminate or control the risk or hazard? What measures do you suggest could be taken in future to avoid a repeat of this incident? Report Incident
