Name and job title of person reporting the incident

Date and time report was made

Details of person subject to violent/ aggressive behaviour

Related incidents (attach relevant report forms)

Date and time of incident

Name(s) of people causing violence or showing aggression

Role of person causing violence or showing aggression (e.g. pupil, visitor, parent, contractor, volunteer)

Full description of the incident including:

Causes and lead up to the incident

Location

All known persons involved

Injuries

Use of offensive weapons (including a description)

Medical treatment required

Presence of emergency services

Who assisted the affected person

Names, roles and address (if non-employee) of witnesses

*Attach statements obtained from witnesses to this form

Staff or pupil absences caused by incident, and length of absence (if known)

Initial actions taken by school

Follow up actions taken by school

Has a risk assessment been carried out? If so, list conclusions and suggested actions

Have outside services (e.g. police, family services, child protection services) been informed? If yes, provide details

Has this incident resulted in any member of staff being absent from work for more than 7 days?

If yes, state who and for how long

RIDDOR Reportable?     Yes/ No        Followed up by Chair of Governors/ HT on (date):