Wings Care
Use this form to report an incident, accident, injury, property damage, or related safety concern.
Date of incident Time of incident AM / PM —Please choose an option—AMPM Area Exact location Street Suburb State Person reporting Contact number Email
Status ParticipantWorkerVisitorPublicOther
Describe what happened Was anyone injured or was any property damaged?
Injury - First Aid TreatmentInjury - Medical TreatmentInjury - HospitalisationMedication IncidentAbuse or NeglectRestrictive PracticeDeathAssaultProperty DamageOther
Name of injured person Date of birth Phone Job title / role Sex MaleFemaleOther
Body part affected HeadFaceEyeNeckShoulderArmHandBackLegFootInternalOther Nature of injury CutBruiseSprain / StrainBurnFractureShockPainStressOther
First aid provided by Was medical attention required? —Please choose an option—YesNo Treatment or action details
Damage description
Name Phone Email