Critical Incident Form

Critical Contact Form

Critical Contact Form

Please use this form when someone (including yourself) has experienced a critical incident and needs follow up from a staff member.

Contact Context


Please round to the nearest 15 minutes.

If any of these options are applicable, please contact Dee or Alex immediately.

Incident Contact Information

The contact(s) is/are the individual(s) who was/is affected by the critical incident. If this is about an experience you had, please fill out your information.

If the contact is known by a different name, please put that information here.

Check all that apply.

Incident Information

Be as specific as possible.

Submission Information