Incident Report Assignment (30%): Using Information from the Cody Case Study: Part 3


Now that you have read parts 1, 2, and 3 of the Case Study, you should have an understanding of the fictional young person, Cody Lang. This assignment will involve part 3 of the Case Study.


This recording format is used to capture important and precise details of a single, specific, and typically time-limited extreme circumstance involving a young person (i.e., an incident). The purpose of this assignment is to provide students with an opportunity to demonstrate mastery of the use of the Incident Report using the case study posted on Blackboard.

In addition to mastering the skills of observing and carefully reporting on the details of a specific incident from the case study, students will have the opportunity to demonstrate the skills of writing for purpose and audience. Remember that telling a colleague about an incident could have a casual focus about detail, language timing, personal reactions, etc., but recording that same incident in a client’s official file, changes the audience and should therefore change the language. This assignment also offers an opportunity to demonstrate writing in an anti-oppressive, strength-based, and objective manner. This assignment expects the student to write using the conventions of professional writing. Finally, students can demonstrate ability to formulate follow up recommendations or plans that address young people’s unmet needs and address safety concerns for moving forward.


Choose 1 of the 2 reports found in the Cody Lang Case Study Part 3. Each of the reports found are in the style of a Daily Log Note, which typically, includes more content than an Incident Report. These writings also contain unethical and unprofessional writing, as defined in the course. Select any one specific incident that you believe should be recorded. Complete the attached Incident Report Template. Imagine and write from the perspective that you are completing the incident report as one of the fictional workers (either Shelly or Elias) identified interacting with Cody. This assignment requires students to:

1. Select a single incident from the case study to complete the Incident Report Template. Accurately record what has occurred by following incident report writing conventions as covered in the course.

2. Complete the report in appropriate professional language, written for a professional audience. Write using unbiased, anti-oppressive, and strengths-based language.

3. Use an objective and descriptive perspective with active voice in your writing. Ensure proper organization with full sentences. Proofread for spelling, grammar, presentation, and accuracy.

4. Your follow up recommendations/plan should be based on the unmet needs and safety concerns with a plan to address issues related to the incident that you have selected.

5. If any information is missing from the case study report, please fill in these details by imagining what makes sense (e.g., exact time, supervisor(s) names, additional necessary details, etc.).

6. Submit on Blackboard in the appropriate assignment drop box in either, .doc, .docx, or .pdf format by the due date. Include the instructions and the rubric (this entire, completed document).

Incident Report Template (complete all sections within text boxes)

Student name and Student Number:



Name of young person:

Cody Lang.

Time frame of incident: (be as specific as possible)



Staff completing the report:

Other staff involved (if applicable):

Other young people involved (if applicable):

What led up to the incident (events immediately prior to the incident; immediate precipitating factors):

Description of the incident and staff response (include the location and a detailed summary of what happened):

Debrief (include details of the debrief with the young person after the incident)

Follow up action (resolutions, safety concerns, persons notified, and further action needed and/or follow up plan):

Names, dates, and time of persons contacted:

Staff signature (typed name):


Rubric for Incident Report Assignment


*Objective and descriptive

* Use of anti-oppressive language and content

* Uses strengths-based language

* Includes young person’s voice

* Respects confidentiality

* Writes for purpose and audience




3.75 – 0

* Writing is objective & non-judgmental

* Tone consistently respectful and professional

* Writing includes strengths and young person’s perspectives

* Confidentiality protected in full

* Purpose and audience considered consistently

* Writing is mostly objective & non-judgmental

* Tone is professional

* Writing includes some strengths and young person’s perspectives

* Confidentiality somewhat protected

*Purpose and audience mostly considered

* Writing is somewhat objective and non-judgmental

* Tone is informal

* Writing includes little strengths and young person’s perspectives

* Little regard for confidentiality demonstrated

* Purpose and audience somewhat considered

* Writing is frequently judgmental and/or subjective

* Tone is casual

* Writing includes little to no strengths or young person’s perspectives

* Confidentiality is not protected

* Little to no consideration of purpose and audience


* Identifies appropriate incident and includes all relevant details

* Incident report is completed in full




1.25 – 0

* Information is completely accurate

* All relevant information included

* Incident report is completed in full

* Information is mostly accurate

* Mostly relevant information included

* Incident report is mostly completed

* Information is minimally accurate

* Some relevant information included

* Incident report is somewhat complete

* Information is inaccurate

* Many irrelevant details included or many relevant details missing

* Many or most sections incomplete


* Spelling and grammar (including use of active voice)

* Use of tense and first or third person perspective

* Sentence structure and organization




1.25 – 0

* Zero spelling errors, full sentences used

* No grammar errors, message is consistently clear

* Tense and perspectives consistent

* Sentences are complete and error free

* Organized presentation

* 1 or 2 spelling errors, mostly full sentences

* Minor grammar errors, message is clear

* Tense and perspectives mostly consistent

* Most sentences complete and error free

* Minimal disorganization

* 3 or 4 spelling errors, some full sentences

* Moderate grammar errors, message is somewhat clear

* Tense and perspectives somewhat consistent

* Several incomplete or run on sentences

* Some disorganization

* More than 4 spelling errors, many sentences are not complete

* Major grammar errors that impact message clarity

* Little to no consistency with tense and perspectives

* Many incomplete or run on sentences

* Little to no organization


* Plan clearly communicated with details of actions

* Addresses safety concerns and unmet needs




1.25 – 0

* Plan is detailed and clear

* Demonstrates attention to all safety considerations and unmet needs

* Plan is somewhat detailed and clear

* Demonstrates attention to most safety considerations and unmet needs

* Plan lacks detail and clarity

* Demonstrates attention to some safety considerations and unmet needs

* Plan has little to no detail or clarity

* Attention to safety considerations and unmet needs minimal or not demonstrated

Total Marks:


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