Accident or Serious Happening Report

COVID-19 SPIRITUAL CARE G.U.I.D.E.

Accident or Serious Happening Report

NOTE: This form is to be completed by the Ministry Coordinator/Supervisor who witnessed and/or was involved in an accident or happening.
Name*
Date of Accident or Occurrence
MM slash DD slash YYYY
Time of Accident or Occurrence
Location*
1. Where exactly did the accident/occurrence happen?
2. Describe in detail what happened.
3. Describe in detail what was done about it
4. List all witnesses.
5. Who was the member/visitorwith at the time of the accident or occurrence?
Name
Phone
6. State the date and time the emergency contact person was contacted.
Supervisor Signature:
Questions or Concerns call the church office at (404) 792-0303
Copy: Lead Pastor of Ministries
Church Administrator

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