Incident Report | Bridgewater Academy

Complete this once the student is safe and cared for. Fields marked required must be filled in before you can submit.

Some required fields are empty

Student and context

Student name

Enter the student's name.

Age

Sex

Grade

Enter the student's grade.

Teacher

Enter the teacher's name.

Date of incident

Enter the date.

Time

Enter the time.

First responder

Enter who responded first.

First aid given by

Place of incident

Nature of incident

Body part and consciousness

What happened

Describe the incident

Describe what happened.

Describe the injury

Describe the injury.

Follow-up questions

Reported by

Your name

Enter your name.

Signature

Sign with a finger, stylus, or mouse. If you can't sign, type your name below instead.

Typed name in place of a signature