View Single Post
missnikki 08:12 AM 11-17-2010
Here's mine, it works for everything. I keep it in my file. It has a spot for everyone's name that was involved, so I make copies for each file. I will only give a copy to a parent if their child was injured.

Program Name

INCIDENT REPORT

DATE___/____/___ TIME _________ CHILD’S NAME______________________
WITNESSES OR OTHERS INVOLVED_______________________________
TYPE OF INCIDENT:
_____INJURY
_____BEHAVIOR
_____OTHER:____________________________________________________
SUMMARY OF INCIDENT:
_______________________________________________________________
DESCRIBE ANY INJURIES:
______________________________________________________________
RESOLUTION OF INCIDENT AND/OR CONSEQUENCES:
_____________________________________________________________
ADDITIONAL COMMENTS:
_________________________________________________________________
PERSON CONTACTED_______________________________TIME___________________

STAFF
PRINT NAME____________________________SIGNATURE________________________
Reply