WSD Student Incident Report
This form is to be completed when a WSD Student gets injured on school property or while participating in a school function (field trip, sporting event, etc).

If the student needs an ambulance, call 911.
Poison control centre - 1-800-332-1414

NOTE: BE SURE TO INFORM THE SCHOOL PRINCIPAL OF THE INCIDENT.
This form is automatically emailed to you after you submit it and notifies the OHS Department.

You can forward to the Principal, Athletic Director, or Superintendent(s) as needed.
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Email *
Your Name *
Your Role *
Were you present at the time of the incident? *
Injured Students attends which School ? *
If Colony School, which one?
Injured student's FIRST Name *
Injured student's LAST Name *
Injured student's grade *
Date and time of Incident *
MM
/
DD
/
YYYY
Time
:
Activity at time of Incident *
Site where Incident Occurred *
If WSD Property, which one?
If Non-WSD School Property, describe
Include school or site name as well as town or city
Location at site where incident occurred *
Brief account of incident *
What happened just before the incident and the incident itself?
Classification of Injury (choose all that apply) *
Required
Description of Injury or Illness. Body part injured (side if applicable) *
Emergency Care provided (First Aid) *
If yes, care administered by:
Care Provided / First Aid given? Choose all that apply
Were parents or guardians contacted or were they in attendance? *
Was 911 called *
Time parents, guardians or 911 were contacted
Time
:
Did staff recommend seeking medical attention?
Clear selection
Was injured student picked up or transported to Hospital or Clinic? *
If yes, what time was the student picked up or transported?
Time
:
If picked up, by whom?
If transported to a hospital or clinic, how were they transported?
Clear selection
Name and Title of WSD Staff Witness(es) if applicable
Name of student witness(es) if applicable
Any other information to add? Pictures can be emailed to laura.stocker@westwind.ab.ca
Notified School Principal or Athletic Director? *
You will receive an email of the submission after you submit this form. You can forward it to him/her.
A copy of your responses will be emailed to the address you provided.
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