School Incident Report Form

July 12, 2011

A  School incident report form is a form which is used to provide complete details of the incident that might have taken place inside the school premises. The incident for which the form has been prepared can be of various different types. These forms can also be used to make claim from the insurance company.

Sample School Incident Report Form



General Information of School


Name of School______________ Name of Principal____________

Address___________ City/State__________ Zip____________
Phone_________ Email_________ Fax_______

Incident Report Information


Date of Incident___/___/___ Time/Hours__________

Place of Incident_____________

Nature of Incident____________ Major Cause of Incident______________

Description of Incident______________

Witnesses of Incident________________ Time when they witnessed it___________

Name and Addresses of Witnesses___________________

When the incident reported to the in charge/administrator: Date/Time_______

Damage it Caused_______________

Any Police Complaint_____________

Person/s Involved in Incident___________ Name/s______________ Address_______

Anyone Injured, if yes then provide details_______________ Name and Address__________

Any medical treatment provided to injured people___________

Name of Hospital/Physician____________ Address____________ Phone_______

Cost of injury treatment__________________

Cost of Damage____________

Receipts of Hospital_________

Total Amount for Claim____________

Report Prepared by: Name_________ Signature____________ Date of Submission____/____/___


Download School Incident Report Form in Word Format

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