PNWK Incident Report

*PNWK Incident Report is for matters relating to any emergency situation or injury in class aside from basic first aid used on students. Basic first aid use should be noted via Brightwheel in student’s profile.

Name of Employee completing incident report:

First Name

Last Name

Name(s) of employees who witnessed the incident:

Name of person(s) impacted by incident or Class Name if the entire class was impacted:

Date of incident:

YYYY

Location of Incident (Park Name, specific location in the park, etc.):

Was 911 Called? If so, by whom? and what is the Report #?

Employee Statement of Incident:

Specific Description of Injury (or injuries), if any:

Other Directly Involved Parties, if any (Please provide, Name and Ph# or Email Address):

Additional Witnesses, if any (Please provide, Name and Ph# or Email Address):

Employee Signature:

First Name

Last Name

PNWK Forest School