Incident Report Form

The Trinidad Renaissance School was designed for everyone. It is part of an international movement in Education and has now twelve affiliate schools worldwide.

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Renaissance Incident Report Form

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Trinidad Renaissance School

1. General Information

Please enter your details as well date and time of incident.

Date of Incident

Time of Incident

Where did the event take place?

2. Injured Party Details

Please enter the details of the injured party/ student

First Name

Last Name

Date of Birth

Year Group

Age

Any known medical condition

If yes please list and or describe

3. Description of the Incident

What happened? (Describe in detail)

Was this witnessed by anyone?

If yes, who?

Were there any contributing factors?

Contributing factors?

Did the student/ individual fall, bump into something, or collide with another student?

4. Response Actions

Response Actions

Who provided first aid?

Was the student placed under observation?

What immediate action was taken?

Was the parent/guardian contacted?

Reason for not contacting the parents.

Who contacted the parent/guardian?

What was communicated to the parent?

5. Injury Details

Description of injury sustained

Type of injury sustained:

Level of pain or discomfort

Strong Pain

Low level of discomfort

No pain reported

Was the student collected early?

Visible signs/symptoms at the time

Describe symtoms

Was any treatment administered?

6. Escalation

Major or Minor Classification

Classification of incident

Was the Head informed immediately

Was emergency medical help called?

Who called?

Did a staff member accompany the individual to the hospital?

7. Staff Details

Who is reporting

First Name

Last Name

POST

Please submit, print and sign hard copy of this report.

Date / Time of report completion

Your Renaissance Email

Trinidad Time

Hours & Info

27-31 Fran St. Cocoyea Village
San Fernando
Trinidad and Tobago

1-868-239-6207

admin@trinidadrenaissance.com

Office Hours: 7:00 am - 4:00 pm

Renaissance

The Renaissance Preparatory School is an Independent Primary School registered with the Ministry of Education, Trinidad and Tobago.

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27-31 Fran St. Cocoyea Village,
San Fernando,
Trinidad and Tobago

admin@trinidadrenaissance.com
headmaster@trinidadrenaissance.com

868-239-6207 / 868-482-5919
868-378-8332 / 868-223-2975