City of Regina | Incident Form for School Bookings

This form is to be used to report incidents that occurred during a community booking at a school and/or damage that was noticed or occurred during a booking. This information will be shared with the applicable school board and may be used for legal purposes if warranted.

Name/Location of Facility*

Reported By (First & Last Name)*

Contact Phone Number*

Contact Email Address*

Date of Occurrence*

Time of Occurrence*

Reported To (name of staff person or supervisor at facility)*

If no staff or supervisor on-site, please enter N/A.

Please describe the incident, extent of damage if applicable and any action taken to remediate the incident*

Provide your observations in chronological order in as much detail as possible. Please stick to facts and refrain from adding personal opinion. Additional documentation (photos, documents etc.) can be attached below.

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By checking this box I acknowledge that the information submitted here is truthful and factual to the best of my knowledge.*

All fields marked with an asterisk (*) are mandatory.

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