INCIDENT REPORT FORM

(Adopted from the National Communications Network)

TYPE OF INCIDENT Infrastructure Damages/

Damage to school resources
DATE AND TIME OF INCIDENT (Indicate the exact date and time when the
incident occured)
EXACT LOCATION OF THE (Indicate the specific venue or location of the
INCIDENT incident)
INVOLVED PERSON/S & (Include full name, age, gender, designation,
SPECIFIC PARTICIPATION grade level, involvement in the incident. If
there are minors involved, names should be
withheld by the SDO-Child Protection
Specialist and/or Division Legal Officer)
NARRATIVE DETAILS OF THE 1. Describe in detail how the incident
INCIDENT happened.
2. Include the effect of the damage to
access to and quality of education.
3. For landslides and erosions, indicate
how near it is to the school structure/s.
4. Include an estimate of the damage cost
or if not possible, an estimate of the repair or
replacement cost. Use back page if needed)
ACTION TAKEN (Narrate responses/decisions implemented by
school authorities. Use back page if needed)
RECOMMENDATIONS (Give suggestions that higher DepEd
Officials/other government agencies must do
to fully respond to the incident.
AGENCIES OR OTHER (Enumerate other authorities involved)
AUTHORITIES NOTIFIED:
PREPARED BY: REVIEWED BY:

_____________________ ________________________
Position/Designation School Head
Date Accomplished