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Bishop Moore Catholic

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Bishop Moore Catholic
HIGH SCHOOL
INCIDENT REPORT
NAME GRADE D.O.B.
SPORT/ACTIVITY COACH
DATE OF INCIDENT TIME OF INCIDENT
LOCATION OF INCIDENT
PARENT/GUARDIAN CONTACT INFO: CELL EMAIL
DETAILED DESCRIPTION OF INCIDENT
POST-INCIDENT PROCEDURES
PARENT NOTIFIED o YES o NO ADMINISTRATION NOTIFIED o YES o NO PARAMEDICS CALLED o YES o NO
DID INCIDENT OCCUR DURING BMC SANCTIONED/SUPERVISED SCHOOL ACTIVITY o YES o NO
IF YES, ACTIVITY SUPERVISOR
SIGNATURE OF PERSON COMPLETING FORM DATE
FOR OFFICE USE ONLY COPIES TO:
o ATHLETIC OFFICE
o ATHLETIC TRAINER
o FINANCE OFFICE
3901 EDGEWATER DRIVE · ORLANDO, FL 32804 · 407-293-7561
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Bishop Moore Catholic

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Completed 26 February 2022

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