Difference between revisions of "Chapter Incident Report"
Pmgingrich (talk | contribs) m |
Pmgingrich (talk | contribs) (removed old footer) |
||
| (2 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
| − | + | In the case of a Chapter crisis or emergency, a '''Chapter Incident Report''' should be completed. | |
| − | ==Individual completing the report | + | ==Individual completing the report== |
Please have one person complete the incident report. | Please have one person complete the incident report. | ||
| Line 37: | Line 37: | ||
| − | ==Name(s) and contact information of individual(s) and chapter(s) involved in the incident | + | ==Name(s) and contact information of individual(s) and chapter(s) involved in the incident== |
Name and Chapter: | Name and Chapter: | ||
| Line 60: | Line 60: | ||
| − | ==Witness(es) | + | ==Witness(es)== |
Name: | Name: | ||
| Line 83: | Line 83: | ||
| − | ==Police Officer(s) Information | + | ==Police Officer(s) Information== |
Were the campus or local police present at the scene of the incident? | Were the campus or local police present at the scene of the incident? | ||
| Line 100: | Line 100: | ||
| − | ==Doctor/hospital information | + | ==Doctor/hospital information== |
Was an injured person(s) taken to the doctor/hospital? | Was an injured person(s) taken to the doctor/hospital? | ||
| Line 113: | Line 113: | ||
| − | ==Name and contact information of the parent(s)/relative(s) that were contacted | + | ==Name and contact information of the parent(s)/relative(s) that were contacted== |
Were the parent(s)/relative(s) of the injured person(s) contacted? | Were the parent(s)/relative(s) of the injured person(s) contacted? | ||
| Line 130: | Line 130: | ||
| − | Please keep a copy of the incident report for the chapter records. Also, send a copy of the incident report to the National Headquarters to be placed in your chapter file. | + | Please keep a copy of the incident report for the chapter records. Also, send a copy of the incident report to the [[National Headquarters]] to be placed in your chapter file. |
Phi Sigma Pi National Headquarters | Phi Sigma Pi National Headquarters | ||
| − | |||
2119 Ambassador Circle | 2119 Ambassador Circle | ||
| + | Lancaster, PA 17603 | ||
| − | |||
(717) 299-4710 | (717) 299-4710 | ||
| − | |||
(800) 366-1916 | (800) 366-1916 | ||
| Line 146: | Line 144: | ||
| − | Date report is being filed | + | Date report is being filed: |
| − | |||
| − | |||
| + | {{Resource Guides Footer}} | ||
| − | + | [[Category:Resource Guides]] | |
[[Category:Risk Management Resource Guide]] | [[Category:Risk Management Resource Guide]] | ||
Latest revision as of 15:22, 17 December 2008
In the case of a Chapter crisis or emergency, a Chapter Incident Report should be completed.
Contents
- 1 Individual completing the report
- 2 Incident Information
- 3 Name(s) and contact information of individual(s) and chapter(s) involved in the incident
- 4 Witness(es)
- 5 Police Officer(s) Information
- 6 Doctor/hospital information
- 7 Name and contact information of the parent(s)/relative(s) that were contacted
Individual completing the report
Please have one person complete the incident report.
Name:
Chapter:
Address:
Telephone #’s:
Email:
Incident Information
Date of incident:
Time of incident:
Location of incident:
Brief Description of incident: Attach additional sheets if necessary
Brief Description of the nature of the event where the incident occurred: Attach additional sheets if necessary
Name(s) and contact information of individual(s) and chapter(s) involved in the incident
Name and Chapter:
Telephone Number:
Email:
Name and Chapter:
Telephone Number:
Email:
Name and Chapter:
Telephone Number:
Email:
Witness(es)
Name:
Telephone #:
Email:
Name:
Telephone #:
Email:
Name:
Telephone #:
Email:
Police Officer(s) Information
Were the campus or local police present at the scene of the incident?
Name:
Office:
Telephone #:
Name:
Office:
Telephone #:
Doctor/hospital information
Was an injured person(s) taken to the doctor/hospital?
Please describe the nature of the injury(ies):
Doctor/Hospital Name:
Address:
Telephone #:
Name and contact information of the parent(s)/relative(s) that were contacted
Were the parent(s)/relative(s) of the injured person(s) contacted?
Name:
Address:
Telephone #:
Email:
Please explain exactly what was reported to the parent(s)/relative(s) of the injured person(s):
Please keep a copy of the incident report for the chapter records. Also, send a copy of the incident report to the National Headquarters to be placed in your chapter file.
Phi Sigma Pi National Headquarters 2119 Ambassador Circle Lancaster, PA 17603
(717) 299-4710
(800) 366-1916
Signature of person filling the report
Date report is being filed:
