Incident Report Q&A Form | |
Name of person reporting incident: |
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Date of incident: |
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Date of report: |
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Your email: |
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Mobile: |
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Landline: |
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Location of incident (town, city): |
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LDP: |
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RDP: |
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ABOUT THE INCIDENT | |
· What is the criticality Level of the incident (where 4 is the least critical and 1 is the most)?
| (See incident categorisation for details) |
· What phase of the programme are you in?
| (E.g. full-time residential, social action project, etc.) |
· Where and when did the incident take place?
| (Physical environment e.g. during a flying fox activity, or in the residential building hallway, etc.) |
· Who are the parties involved?
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· Who witnessed the incident?
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· What happened in the lead-up to the incident?
| (Give details on any factors that may have contributed e.g. past arguments between two YP’s, detail any pre-existing conditions or situations that may have affected the persons involved)
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· Describe the incident itself – what happened & who was involved?
| (Provide as much detail as possible) |
· Briefly what is the current situation at the time of writing?
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· Are any charges being brought?
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HEALTH & SAFETY | |
· Have the appropriate authorities been contacted? E.g. police, ambulance, fire services
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· Are any other people at risk? Have they been removed from that risk?
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· What is the current condition and location of the individual(s) affected?
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· Is there a need for counselling to be provided, does the RDP have provision for counselling in place?
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· What is the ongoing plan to keep relevant stakeholders informed (i.e. young people / parents, where counselling may be necessary)
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EFFECT ON PROGRAMME | |
· Is there any disruption to the programme?
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· Does the programme need to be shut down?
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· Have parents / guardians of those affected been contacted?
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· What provisions have been made for the safe return of young people to their homes?
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MEDIA IMPACT & ONGOING COMMS | |
· Have YP been asked to refrain from communicating about the incident by phone or social media?
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· Has there been any comment on social media? (Include links or names)
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· Has there been any media interest?
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· Please provide contact details for the person responsible for social media in your organization
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· Please provide contact details for the person responsible for PR in your organization
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ADDITIONAL INFORMATION | |
(Please provide any further details you may have relating to the incident or those involved that does not apply to any of the questions above)
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