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Accident Report

The document is an Incident Report Form used by Allen Central Elementary School in the Philippines. It outlines sections for detailing the type of incident, date and time, location, involved persons, narrative details, actions taken, recommendations, and reporter information. The form is intended for documenting incidents affecting students and the school community.

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silver.bacus
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38 views2 pages

Accident Report

The document is an Incident Report Form used by Allen Central Elementary School in the Philippines. It outlines sections for detailing the type of incident, date and time, location, involved persons, narrative details, actions taken, recommendations, and reporter information. The form is intended for documenting incidents affecting students and the school community.

Uploaded by

silver.bacus
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Republic of the Philippines

Regional Office VIII


Allen Central Elementary School
Kinabrana I, Allen Northern Samar

INCIDENT REPORT FORM

TYPE OF INCIDENT:

INCLUSIVE DATE AND TIME OF INCIDENT:

EXACT LOCATION OF INCIDENT: (room, building, area, sitio, barangay, municipal,etc.)

INVOLVED PERSONS &SPECIFIC PARTICIPATION: (full name, age, gender, position designation on grade level,
involvement in the accident.)

D
NARRATIVE DETAILS OF INCIDENT: (Describe how the incident happened, area of incident, physically and mentally state of
involve persons, impact to class school /community, etc. used back space if needed)

ACTION/S TAKEN: (narrate responses/ decisions implemented by school authority, state name of officials. Use back
space if you needed.)

RECOMMENDATIONS: (State suggestion that higher DepEd officials, other government agencies that perform further
to fully respond to situation. Use back space if needed)

REPORTER BY: (full name, position/designation and signature) DATE RECEIVED:

Teacher I/ Guidance Advocate


Child Protection Coordinator

REVIEWED BY: full name, position/designation and signature) RECEIVED BY:

SCHOOL PRINCIPAL IV

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