First Aid & Mental Health Incident Report

First Aid & Mental Health Incident Report

Responders Name

Responders Email

Date of issue/injury*

Time of issue/injury?

Injured/Impacted Person Name

Impacted Person Age

Impacted Person Engagement Role

Please select from drop down.

Select

Where did this occur?

What was the nature of the issue/injury?

Was First Aid required? If yes, please detail.

Was mental health aid required? If yes, please detail.

Was the person able to self-manage their wellbeing?

Individuals emergency contact called? If yes, for what purpose?

Was 000 called? If yes, what course of action was taken?

Were they transferred to hospital? If yes, please detail

Did person leave camp by own volition? If yes, please detail.

Were there any witnesses? If yes, please detail.

Further investigation required?

Yes

Does the severity of incident require a Work Safe report?

Yes

Did the incident result in...

Please choose from drop down.

Select