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Please use this form to document any:

accident
injury
illness
incident
times when admin its called to assist (formerly when a child needed to be removed from the classroom)
any time a child is missed in a name to face/returned by another staff member

This form should be filled out first, and then the incident or activity should be documented both ‘staff only’ and appropriately shared with the parents either by the teachers or office staff.

Name of Teacher Filling Out Report

First Name

Last Name

Classroom

List Other Staff Members Present In Classroom

Date of Incident

YYYY

Time of Incident

Hour

Minute

Second

Location Of Incident

Were you in your classroom? On the Playground? In the Hallway? Please be specific.

Names of Children Involved

Please only put one child's name on each line.

Second Child's Name

Third Child's Name

Additional Children Involved

I believe this is a

MINOR INCIDENT - requires first aid

MAJOR INCIDENT - could require advanced care

I am unsure, I'd like the office to decide

Describe What Happened

Please be very detailed in your description of what happened. Use both children's names and provide all details, including where each staff member was during the incident.

What Did Staff Do Following the Incident?

such as applying first aid, offering care, separating the kids,

What Could Have Been Done To Prevent the Incident?

Please include details!

Would you like to send message to the parents through brightwheel, or would you like the office to take care of that?

Bites and serious concerns need to be communicated by the office