Facility Incident Report

In the event of an injury or damage to a school district facility during use under School Board Policy KG, "Public Use of School Facilities", this form must be completed within 24 hours of the incident.

Facility Incident Report:

Facility Incident Report
1.
*

Name of user/group: 

2.
*

Date of use: 

3.
*

Time of use: 

4.
*

Explain what/how property was damaged:

5.
*

Explain in detail who was hurt and how:

6.
*

List witness(es) to the event (full name and phone number for each):

This form was completed by:

7.
*

First Name:

8.
*

Last Name:

9.
*

Phone Number:

* Enter Your Email Address:

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