Incident Report Form

  • Incident Report Form

  • This form MUST be completed and submitted to Girl Scouts of Western Washington council within 24-72 hours after the event.

    Report Writing Reminders

    • Each description should be complete, detailed, fact based, and unbiased. 
    • If you are being told something, then clearly state who told you and what was said. 
    • If you experienced or observed the incident, then state exactly what and how much you witnessed. 
    • If you are not the witness specify who reported incident (for example, Camper A stated ... to Camper B)
    • Ensure full legal names (not camp names) of impacted individuals and witnesses are listed. 
    • If you are unsure how to answer a question, please use the phrase "contact me."
    • If a question doesn't apply to the situation, respond using "N/A" or "Not Applicable."
    • Any questions or concerns, please call (800) 541-9852.
  • Category of Incident*
  • Due to standards set by the American Camp Association, incidents that take place during camp require additional documentation. Did this incident occur during a volunteer-led camp?*
  • Did the incident involve Girl Scouts of Western Washington staff members?*
  • How would you like to complete the incident report?*

  • Location and Participants

  • Where did this incident occur?*
  • Date and Time of Incident*
     - -
  • What Girl Scout property?*
  • Is the affected person a youth?*
  • Format: (000) 000-0000.

  • Incident Details

  • CPS Reporting

  • Have you reported your suspicions of abuse or neglect to Child Protective Services?*

  • Property Damage

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Injury / Illness

  • Estimated time between injury and first aid: and arrival of Emergency Medical Services: .

  • Injury Level
  • Did the affected person refuse medical treatment?
  • Affected person was released to:*
  • Format: (000) 000-0000.

  • Law Enforcement Interactions

  • Was a participant and/or GS member arrested or detained from this interaction?

  • Attachments

  • If you have pictures or copies of any warrants presented / items seized, please attach them below. 

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  • Submitter Details

  • Format: (000) 000-0000.
  • Clear
  • Should be Empty: