Incident Reporting Tool



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Incident Reporting Tool (Events or allegations of injury, illness, or property damage, including employment and directors and officer’s issues) General Incident Details Required Fields Incident Date: Incident Time (in 24-hour format): Report Date: Date Reported to Council/BSA Location: Reported by Name: Reported by Primary Phone: Reported by Secondary Phone: Reported by Email: Reported by Address: Reported by City: Reported by State: Reported by Zip Code: Council/BSA Location: Location of Incident: Specific area where incident occurred: Incident Address: Incident City: Incident State: Incident Zip Code: Description of Incident (clear/concise/complete facts): Was an Agency or Authority Notified ❏ Yes ❏ No Whom: Injury/Illness/Damage Information Claimant Name: Claimant Address:




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