Incident Report – International Friendships, Inc (IFI)

Incident/Injury Report

IFI is committed to providing international students, volunteers, and their employees with the safest environment possible. To that end, we collect information as near misses and injuries occur. This information helps us improve coaching, revise training, and consider new resources to keep everyone safe and healthy. Please fill out this form within 4 hours of any incident that results, or could have resulted, in injury to you or IFI property. Example of a near miss: Something was improperly stacked and almost hit you when it fell.

Name(Required)

First Last

Email(Required)

Location(Required)

City State

Date of Incident(Required)

Time of Incident

Location of Incident(Required)

Witnesses

Comments

First Aid Given?(Required)

Yes

By Whom?

Did you, or do you think you will, seek medical treatment?(Required)

Yes

Nature and extent of injuries (body part or property affected)(Required)

What job or activity was being engaged in at time of incident?(Required)

How did the incident occur?

Describe any condition or actions that contributed to the accident