Incident Report

 Incident/Accident Report Form

Date of Incident:
Time:
Child’s Name:
Description of Incident: (Briefly describe what happened)

Action Taken:
Was First Aid Administered?
• Yes / No (If yes, describe)

Witness (if applicable):
Follow-Up Actions: (e.g., monitoring, parent notification)

Parent/Guardian Notified By:
Parent/Guardian Signature:
Date: