Incident Report Tool

Timely, clear, concise, and complete incident reports allow for an appropriate response and an opportunity for analysis while promoting continuous improvement of our programs. You can report incidents, near misses, and youth protection / membership infraction incidents to your local council or enter them yourself.

Types of Reports:

NEAR MISS: ** DO NOT USE THIS FOR COVID REPORTING **
Only choose this if your incident was an unplanned event that DID NOT result in injury, illness or damage – but had the potential to do so. **Please Note that Youth Protection or Behavioral Issues should be submitted using the Membership Infraction option.

MEMBERSHIP INFRACTION
Choose this if your incident dealt with behavior that puts a Scout’s safety at risk, such as Youth Protection violations, allegations of abuse, self-harm, etc. Or that calls into question a registered leader or youth member’s continued registration with BSA.

GENERAL LIABILITY: ** USE THIS FOR COVID REPORTING **
Allegations of bodily injury, illness or property damage including employment matters.

BSA Incident Reporting Info

BSA Claim Form – HSR

[Download clickable PDF]

TIP: Since this is a long form, please use the SAVE option at the bottom to save your work as you go. You can then return to the submission at any point from the email link it sends you.

NOTE!! If you do not receive a confirmation email, then it was not submitted properly. Please reach out to us if you try to submit but do not receive an email address. rebecca.alberda@scouting.org

Incident Reporting Tool

Use this form to report all injuries, illnesses, and incidents during Scouting activities or on council-owned properties that require the intervention of a medical provider beyond basic Scout-rendered first aid.

General Incident Details

Type of Activity(Required)

Type of Report(Required)

Incident Date(Required)

Incident Time

24-hour format

Report Date(Required)

Date Reported to Council/BSA Location(Required)

Reported by Name(Required)

Person completing this form

First Last

Reported by Primary Phone

Reported by Secondary Phone

Reported by Email(Required)

Reported by Address(Required)

Street Address Address Line 2 City State ZIP Code

Council/BSA Location(Required)

Council name. If at BSA National property, specify that in place of council. E.g., "Michigan Crossroads Council" or "Florida Sea Base"

Location of Incident(Required)

Specific area where incident occurred

For larger locations, specify a detailed location. E.g., "dining hall" or "north section of trail by bridge"

Incident Address

At minimum, City and State, if no specific address (e.g., on a trail or waterway).

Street Address Address Line 2 City State ZIP Code

Description of Incident(Required)

Provide clear, concise, and complete facts of what occurred.

Lessons Learned(Required)

Was an Agency or Authority notified?(Required)

E.g., Police, park service.

Yes

Which Agency/Authority was Notified

If applicable, was appropriate children and family services/Child Protective Service agency notified?(Required)

Yes

Name of children/family services agency

General Classification of Claimant/Near Miss(Required)

General Classification "Other"

Alleged Victim/Target/Injured Party

Alleged Victim/Target Name(Required)

First Last

Alleged Victim/Target Type(Required)

Check all that apply

Adult

Youth

Registered

Other

Alleged Victim/Target Parent Info

Alleged Victim/Target Council, Unit and Chartered Org(Required)

Alleged Victim/Target DOB(Required)

Alleged Victim/Target Age(Required)

Alleged Victim/Target Gender(Required)

Alleged Victim/Target Address

Street Address Address Line 2 City State ZIP Code

Alleged Victim/Target Email(Required)

Alleged Victim/Target Primary Phone(Required)

Alleged Victim/Target Secondary Phone

Alleged Victim Parent Notified?(Required)

Yes

Alleged Victim Parent Notified by whom?(Required)

Date of Alleged Victim Parent Notification(Required)

Alleged Policy Violator/Offender Information

Alleged Policy Violator Name(Required)

First Last

Alleged Policy Violator Type(Required)

Check all that apply

Adult

Youth

Registered

Other

Alleged Policy Violator Parent Info

Alleged Policy Violator Council, Unit, Chartered Org(Required)

Alleged Policy Violator DOB(Required)

Alleged Policy Violator Age(Required)

Alleged Policy Violator Gender(Required)

Alleged Policy Violator Address

Street Address Address Line 2 City State ZIP Code

Alleged Policy Violator Primary Phone(Required)

Alleged Policy Violator Secondary Phone

Alleged Policy Violator Email(Required)

Alleged Violator Parent Notified?(Required)

Yes

Alleged Violator Parent Notified by Whom?

Alleged Violator Parent Notification Date

Injury/Illness/Damage Information

Claimant Name(Required)

Name of person who was injured or sustained damage

First Last

Claimant Address

Street Address Address Line 2 City State ZIP Code

Claimant Email(Required)

Claimant Date of Birth

Age of Claimant

Please enter a number from 0 to 110.

Claimant Chartered Organization

Add a second Claimant?

Yes

Second Claimant Name(Required)

Name of person who was injured or sustained damage

First Last

Second Claimant Address

Street Address Address Line 2 City State ZIP Code

Second Claimant Email(Required)

Second Claimant Date of Birth

Age of Second Claimant

Please enter a number from 0 to 110.

Second Claimant Chartered Organization

Add a third Claimant?

Yes

Third Claimant Name(Required)

Name of person who was injured or sustained damage

First Last

Third Claimant Address

Street Address Address Line 2 City State ZIP Code

Third Claimant Email(Required)

Third Claimant Date of Birth

Age of Third Claimant

Please enter a number from 0 to 110.

Third Claimant Chartered Organization

Add a fourth Claimant?

Yes

Fourth Claimant Name(Required)

Name of person who was injured or sustained damage

First Last

Fourth Claimant Address

Street Address Address Line 2 City State ZIP Code

Fourth Claimant Email(Required)

Fourth Claimant Date of Birth

Age of Fourth Claimant

Please enter a number from 0 to 110.

Fourth Claimant Chartered Organization

Property Damage?(Required)

Yes

Property Damage Description

Adventure/Program/Event(Required)

Name of event at which incident occurred. E.g., "Summer camp at X", "20 mile hike", or "Troop meeting"

Cause/Nature/Injury Detail(Required)

Additional details

If medical treatment was provided, please describe(Required)

If transported by air/ambulance, please describe

Are Accident and Sickness forms provided or filed?(Required)

Yes

Unknown

If certificate of insurance has been provided, please describe

If there is/was a contract for this event, please describe

Did the event occur while transporting to/from activity?

Yes

Unknown

Vehicle(s) Involved

Vehicle and Driver Information

Owner of Vehicle	Vehicle License State	VIN	Vehicle Make/Model/Year	Driver Name	Driver Phone	Actions

There are no Entries.

Weather Conditions

Conditions at time of incident

Witnesses

Witness Form

Witness Name	Witness Email	Witness Type	Witness Primary Phone	Actions

There are no Entries.

Supporting Documents

Attachments

Photos, statements and other supporting details can be uploaded here.

Drop files here or

Max. file size: 2 GB.

Incident Report Tool

Incident Reporting Tool

General Incident Details

Alleged Victim/Target/Injured Party

Alleged Policy Violator/Offender Information

Injury/Illness/Damage Information

Vehicle(s) Involved

Witnesses

Supporting Documents

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