The incident report form is required for serious illnesses, significant behavioral problems, or incidents involving injuries such as fractured bones, chipped or broken teeth, lacerations involving sutures, falls involving unconsciousness or injury, dislocations, incidents involving water which require resuscitation, or any injury requiring a hospital visit.  This incident report form is NOT required for minor incidents such as scrapes, bruises, sprains, poison ivy, etc.

The completed form should be retained in the Extension Office, with a copy being sent to the appropriate District Director.

Incident Report Form



Any time a confrontational incident occurs between an agent/parent/adult or teen volunteer/child or youth (in any combination) it should be documented in writing through an incident report form. The confrontation may be verbal or physical. Documentation is also necessary when there is a major rule violation, regardless of whether or not there is a one-on-one confrontation. Documentation will protect the Kentucky Cooperative Extension Service, staff, and volunteers should there be a question as to how the situation was handled or if legal action should arise.

Incidents that happen at 4-H camps or at state sponsored events are to be filed with the Department of 4‑H Youth Development Department, or the appropriate state office and Assistant Director.

It is recommended that the staff assistants in the Extension Office be responsible for clipping items from the local newspaper and Extension newsletter, to be added to the respective volunteer file.  Additionally, awards nominations and certification information are all examples of information that should be included in individual volunteer files.