Project Horse Internal Reporting


Equine/Client Incident and Safety Plan Report

Facilitating staff is required to submit this report within 2 business days of incident.

    Report Submitted By *
    Report Submitted By
    Date of Incident *
    Date of Incident
    Time Incident Occurred *
    Time Incident Occurred
    MH Professional #1
    MH Professional #1
    MH Professional #2 (If Applicable)
    MH Professional #2 (If Applicable)
    ES Professional #1
    ES Professional #1
    ES Professional #2 (If Applicable)
    ES Professional #2 (If Applicable)
    Client Name
    Client Name
    Please Check All that Apply Right Now *