Resources
Resources Overview
Conference Room Reservations
Agency Resources
CAP 60
Early Childhood Services
Building & Energy Services Team
Fiscal
Purchase Requests
Human Resources
IT
Marketing and Communications
The More You Know About CEO
Community Services
Quality Assurance
Training
Workplace Safety
CEO Stars
See all CEO Stars
CEO Stars Nomination Process
CEO Events Calendar
Recent Staff Changes
Board Members
Select Page
Search for:
Resources
Conference Room Reservations
Agency Resources
CAP 60
Early Childhood Services
Building & Energy Services Team
Fiscal
Purchase Requests
Human Resources
Job Order Form
Department of Labor Postings
Request for Bereavement Leave
Condolence-sympathy acknowledgment
Harassment Reporting Form
Employee Stay Interview
IT
Marketing and Communications
Business Card Requests
The More You Know About CEO
Community Services
Quality Assurance
Training
Workplace Safety
Quick Links
View CEO's Values
Purchase Requests
Employee Handbook
Access ADP
Agency Phone List
Online Webmail Portal
Home
5
2026 Incident/Accident Report
2026 Incident/Accident Report
2026 Incident/Accident Report
Form completed by:
(Required)
Email of staff member completing the form:
(Required)
Email for the direct supervisor of staff member completeing the form:
(Required)
Date Form Completed:
(Required)
MM slash DD slash YYYY
Date of Incident/Accident:
(Required)
MM slash DD slash YYYY
Time of Incident/Accident:
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Program:
(Required)
Early Childhood Services
Community Services
BEST
Administration
Location of Incident/Accident:
(Required)
CRC
Bridge
SFRC
LFRC
HFFRC
RFRC
School 12
School 2
Hoosic Valley
Rensselaer
Admin
TFRC
5th Ave
In the Field
Incident/Accident Type:
(Required)
Serious Incident of a Child/Customer/Guest
Serious Injury of a Child/Customer/Guest
Staff Accident
CEO Code of Conduct Violation
CEO Zero Tolerance Violation
Vehicle Accident
Stating facts, describe the incident:
(Required)
Please include a description of the events that occurred prior that may have caused the incident or accident. Include names of the people involved, if applicable.
Names and Contact Information for Individuals Involved:
Please include all staff, customers, children, and individuals involved.
Please upload any relevant documents to this incident:
Max. file size: 512 MB.
Including vehicle accident forms, observations forms, etc. ECS Managers do not need to include forms that are already in the Incident G:Drive.
Δ
