INCIDENT REPORT FOR CHILD DAY CARE

INCIDENT REPORT FOR CHILD DAY CARE =

􀃖 &nb= sp; This form may be used to maintain a record of each child’s illnesses, accidents, injuries, signs of abuse, etc. = 􀃖 Share a completed copy with parents.
Name of Child	Age
Details of Incident
Date	Type
Time	Place	(accident Illness Etc)
(Kitchen, playground, etc.)
Describe Incident :

Injuries :

Medical Services Provided:

Parent/Guardian/Other Notified
Name &nbs= p;	Ti= me	Date<= /span>
Name	Time	Date<= /span>

Witnesses
Name
Name
=
Staff	Da= te________

= &nb= sp; = (Print= Name)