CONFIDENTIAL INCIDENT REPORT FORM

This form is to be filled out in detail when any issue of safety or security takes place at CFG or CFG events. Any incidents involving racism, sexism, prejudice, harassment, hateful speech, bullying behaviour, or other concerning practices should be documented in this confidential incident report and will be addressed quickly. Additionally, any disclosure of abuse (sexual, physical, emotional or involving neglect) should be reported on a confidential incident report form. Any other sensitive or concerning situation can also be documented in a confidential incident report form.

All details of any of the above situations being dealt with are to be included in this form, (along with any other relevant documentation). Always include dates, times, and locations of meetings and the names of all involved. Please give as much information and detail as possible as these forms help ensure the safety of all CFG attendees.

We go by this model at CFG: when in doubt, fill it out. Please fill out this form if there is any indication that a report should be kept of an event or situation. Care must be taken to make sure that all data recorded is exactly as it was stated to you.

Name

First Name

Last Name

Date

TODAY'S DATE

YYYY

Date

DATE OF INCIDENT BEING REPORTED

YYYY

Name(s) of People Involved in the Incident

If possible add in brackets how they were involved. For example: John Smith (Victim), Jane Doe (Associate Pastor)

Location

Where did this event take place and at what event?

Type of Incident

Incident/Issue Description

Please be as specific as possible - e.g. time, who was involved, location, etc.

Action(s) taken

Please be as specific as possible - e.g. time, who was involved, location, who was called, etc. (Write N/A or leave blank if you are not aware of any actions taken)

Outcome(s)

Please be as specific as possible - e.g. time, who was involved, location, etc. (Write N/A or leave blank if you are not aware of any outcomes)

By checking this box I certify all above information is true and correct to the best of my knowledge.

Yes

FOLLOW UP

A CFG Staff or Leadership member will reach out to you soon. If you do not hear back within a couple days, please email office@calgaryfullgospel.com to follow up. Thank you for taking the time to fill out this report.