Incident Reporting Form & Policy
Animal Shelter Program – Charity Helpers Foundation
Document ID: CHF-IRF-015
Date: March 26, 2025

This policy and form are to be used by any participant in the Animal Shelter Program under Charity Helpers Foundation (EIN: 873593600) to report major incidents involving safety, animal welfare, or serious operational issues.


1. Purpose

To maintain transparency, protect animals and people, and ensure appropriate response to incidents that could impact the health, safety, legal standing, or public image of the shelter or the foundation.


2. When to Use This Form

This form must be completed within 24 hours of any of the following:


3. Reporting Procedure

  1. Complete the form below in full
  2. Submit to the Program Lead and Charity Helpers Foundation within 24 hours
  3. Program Lead will confirm receipt and initiate any follow-up steps

If the Program Lead is involved in or unable to respond to the incident, the form should be sent directly to the Foundation at: [Insert email/contact info]


4. Incident Reporting Form

Type of Incident (check all that apply):

Describe the Incident in Detail:




Names of Involved Individuals (if known):


Immediate Actions Taken:



Was emergency assistance required? [ ] Yes [ ] No
If yes, provide details: ____________________________________________


5. Signatures

Person Reporting: __________________________
Date: __________________

Program Lead (if applicable): _______________________
Date Received: __________________

For Internal Use – CHF Follow-Up Notes: