Once form is submitted, please confirm that HR has indeed received this.

Your Name

First Name

Last Name

Date of Incident

YYYY

Approximate Time of Incident

Hour

Minute

Second

Location of Incident

Client's Name

First Name

Last Name

Contact information for this client

Please list any other names and contact information for any others that were involved in this matter.

Please list any available names and contact information of parents, guardians that were involved in this incident and list which client they are connected to.

Description of Incident

Please give as many details as possible

If any injuries were incurred, please provide a detailed description of injuries and steps taken (if any) to assist those injured.

Name of attending health professional or police officer. Please provide identification number/badge number.

What action steps were taken at time of incident to ensure safety of clientele, your team members and others involved?

What medical attention was obtained?

Please list names of hospitals or clinics if applicable

Please list any foreseeable future risk and the follow up that is intended.

Name of witness #1

First Name

Last Name

Phone

(###)

###

####

Name of witness #2

First Name

Last Name

Phone 1

(###)

###

####

Further comments:

Youth Unlimited Greater Calgary

YOUTH UNLIMITED GREATER CALGARY ENVISIONS THAT YOUNG PEOPLE, AS THEY EXPERIENCE GOD, HIS LOVE, HIS TRUTH, AND HIS LIFE CHANGING POWER WILL BE TRANSFORMED AND WILL BE A REDEMPTIVE PRESENCE IN OUR CITY AND BEYOND.

If you're looking to volunteer in or around Calgary or to become a youth ministry worker in our community, Youth Unlimited might be the organization for you.

WE INVITE YOU TO BROWSE THROUGH OUR WEBSITE TO FIND OUT MORE ABOUT US AND THE WORK THAT GOD IS DOING THROUGH OUR MINISTRY TEAM. WE CHALLENGE YOU TO ASK GOD HOW YOU CAN BECOME A PART OF CHANGING THE LIVES OF YOUTH, ALLOWING GOD TO USE YOU AND YOUR RESOURCES TO BE A PART OF AN INCREDIBLE MINISTRY AND BRINGING YOUTH TO THE KNOWLEDGE OF CHRIST!

Contact.

OFFICE: 403.291.3179
TOLL FREE: 1.888.753.8575
EMAIL: calgary@yfc.ca

GREATER CALGARY OFFICE
Bay #15, 1725 - 30th Avenue NE
Calgary, AB T2E 7P6

CHARITABLE REGISTRATION
130764020RR0001

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Incident Report

Youth Unlimited Greater Calgary

Contact.