Redwood Incident Report Form

Date / Time of Incident *

Date

Time

Name of person completing form *

First

Last

Type of incident: *

• Behavior
• Injury

Name of student involved *

First

Last

Description of incident (what happened, how it happened, factors leading to the event, etc) Be as specific as possible. *

Upload a photo (if applicable)

Click or drag files to this area to upload. You can upload up to 3 files.

What action was taken by the school? (ie. ice, bandaid, contacting parents/guardians, or any additional emergency care) *

If injury indicated, was additional medical attention needed (outside of Redwood)?

• Yes
• No

If yes, please describe:

Were there any witnesses to the incident?

• Yes
• No

If yes, please list names and any contact information

Date of report *

Submit