Incident Report Form

Use this form if an incident or accident occurred to a Girl Scout member during a Girl Scout activity. Fill out 1 form for each incident or person.

Person Involved

Relationship to GSSNV

Witnesses

Upload any signed statements you wish to attach here

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Incident Details

Type of Incident
Was the person involved injured?
If the person involved was injured, were they participating in an activity at the time of the injury?
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Submission Details