Skip to main content

Incident Injury Report Form (Sample)

Written by admin on .

No one ever wants to see someone get injured, especially at church or a church-related event. If an injury were to occur, we developed an Incident/Injury Report Form to assist churches in managing the unfortunate occurrence. This sample form provides an outline to help document the details of the occurrence and provides an area to list the contact information for whom the incident should promptly be reported to for handling a potential claim (we would suggest contacting your local, friendly, independent insurance agent). This sample form is available free for your congregation’s use, just download it by clicking on the above link.

Request Information

Thank you for your interest in Mennonite Mutual. Please provide your information below. A member of our team will be in touch shortly to address your inquiry.
Please enable JavaScript in your browser to complete this form.
Name
Address

DISCLAIMER:Messaging and data charges may apply, and you can opt out at any time by replying STOP or clicking HELP for more information. We do not collect your information and provide it to third-party services for processing. The phone numbers we collect and the consent we receive will not be shared with third-party providers.

No mobile information will be shared with third parties and affiliates for marketing or promotional purposes. All other categories exclude text messaging originator opt-in and consent; this information will not be shared with any thrid parties. For more information on our privacy policy, visit https://www.mennonitemutual.com/privacy