Incident Report

2025 ADTC Incident Report Form

Please report any out of the ordinary incident that occurs at camp (injury, illness, property damage, bullying, extreme homesickness, staff issues, etc.) by immediately completing this form. Each person involved in the incident at any time should fill out this report. Please provide details of your experience of the incident, and not the opinion discussed as a group.

"*" indicates required fields

Your Name*
Example: Afternoon dance tricks elective.
Date of the incident*
Time of the incident*
:
Example: Outside on marley during the elective class.
Witness Name #1*
Witness Name #2

Complete this section only if the incident was reported to police

Name of Officer in Charge

Reporting Details

Name of doctor or nurse consulted
Address of Hospital or Clinic

Complete this section only if outside medical attention was sought

Staff Member's Digital Signature*
Today's Date*