Incident Reporting Form

At City on a Hill we seek to maintain a safe environment for everyone to hear the good news about Jesus. Please use this form to report any incidents where someone has been injured (or nearly injured) so that we can ensure we can care for them and maintain a safe church environment.

Completed forms will be emailed to the Admin Team who oversee our health and safety policies and register.

ALL INCIDENTS SHOULD BE REPORTED WITHIN SEVEN (7) DAYS

Section A - The Details

Name of person reporting incident

First Name

Last Name

Date of Report

MM

DD

YYYY

Date of Incident

MM

DD

YYYY

Time of Incident

Hour

Minute

Second

Type of Incident

Which area of church did the incident take place?

e.g. Kids church, morning tea, setup/packup, etc.

Names and details of affected parties

Section B - The Incident

Incident / Issue description

Describe what happened

Action(s) taken

Outcome(s) if known

Section C - The Analysis

Is this type of incident new or old?

New

Old

Is this type of incident one-off or ongoing?

One-off

Ongoing

Has this type of incident been increasing?

Yes

No

Have appropriate steps been taken to address this incident?

Yes

No

If 'no', what needs to be done?

Incident Reporting Form

This Sunday:

10am - 11 hutchinson Rd

6pm - 39 Webb St

Also streaming online