INCIDENT REPORT

LEASE TENANT-INCIDENT REPORT

Name of person submitting INCIDENT REPORT on behalf of Chatham Kent Cougars Football Club * Required
First Last
Cell number * Required
Email address * Required
Type of incident being reported * Required
- Injury Report
- Property Damage Report
- Other Urgent or Emergency Situation Report
INJURY REPORT
Please complete this section if an Injury occurred within the shared/leased spaces, identified in the lease agreement. If the injury occurred during a community use of schools booking, in spaces other than those identified in the lease agreement then please go to this page of the CLASS website to complete the Community Use of Schools Injury Report - https://cklass.ca/injury-reporting/
Time and date of the incident * Required
Location of the incident * Required
Nature of the incident (e.g. slip or fall) * Required
Description of the injury (e.g. broken finger on left hand) * Required
Description of the incident and how it occurred * Required
e.g. John Smith was putting away the football helmets and tripped over items on the floor and he broke a finger on his left hand.
Injured person (first & last name) * Required
If you also know their home address and phone # please include that information.
Action taken (check all that apply)
- Administered First Aid
- Contacted EMS/Called 911
- Taken to hospital by ambulance
- Hospitalized - Treated and released
- Hospitalized - Admitted
Witness (first & last name) * Required
If you also know their home address and phone # please include that information.
Was the injury sustained a Critial Injury? Indicate YES or NO * Required
A Critical Injury is an injury that places life in jeopardy; produces unconsciousness; results in substantial blood loss; involves the fracture of a leg or an arm or amputation of a leg, arm, hand or foot; consists of burns to a major portion of the body; or causes the loss of sight in an eye.
PROPERTY DAMAGE REPORT
Please complete this section if the damage(s) occurred within the shared/leased spaces, identified in the lease agreement. If the damage(s) occurred during a community use of schools booking, in spaces other than those identified in the lease agreement then please go to this page of the CLASS website to complete the Community Use of Schools Damage Report - https://cklass.ca/damage-report/
Time and date the damage occurred * Required
Location of the damage * Required
Description of the damage and how it occurred * Required
e.g. John Smith broke a window in the leased barn space while putting away the football equipment.
OTHER URGENT OR EMERGENCY SITUATION REPORT
Please complete this section if am urgent or emergency situation occurred, other than an injury or damages, within the shared/leased spaces, identified in the lease agreement. If the incident occurred during a community use of schools booking, in spaces other than those identified in the lease agreement then please contact the Community Use of Schools Rental Office - communityuseofschools@cklass.ca
Description of the incident and how it occurred * Required

CLASS Shared School Services

2 days ago

Energy & Environment team here to remind you about idling - running your vehicle engine when you're not driving it. Idling reduces your vehicle's fuel economy, costs money, and creates pollution.
If you idle for 10 minutes per day during school drop-off and pickup, you will waste an average of $98 of gas per school year.
To prevent the carbon emissions associated with idling (and to save💲) please turn off your vehicle during school drop-off and pickups. ... See MoreSee Less

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6 days ago

If your child is in JK or SK, they must be met at the bus stop every day by a parent or guardian. Be sure to attach a yellow bus tag to their backpack to identify to the driver they must be met. Need a tag? Ask at your school office! ... See MoreSee Less

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1 week ago

International Biodiversity Day is celebrated annually on May 22. Biodiversity remains the answer to several sustainable development challenges. From nature-based solutions to climate issues, food and water security, and sustainable livelihoods, biodiversity is the foundation upon which we can build back better.

You can find out ways to contribute and participate by visiting www.cbd.int/biodiversity-day and checking out the 22 Actions for Biodiversity. ... See MoreSee Less

INCIDENT REPORT

LEASE TENANT-INCIDENT REPORT

INJURY REPORT

PROPERTY DAMAGE REPORT

OTHER URGENT OR EMERGENCY SITUATION REPORT