(Daycare Forms)     (Home)       (Contact Us)

Accident Report

 Please feel free to copy and paste these samples and or change them  to suit your needs!

Child's Name:________________________________________________________________________________

Date Accident occurred: ___________________________ Time Accident occurred:_________________________

What was injured and where? ____________________________________________________________________

What was child doing?__________________________________________________________________________

____________________________________________________________________________________________

First aid :____________________________________________________________________________________

Additional Information__________________________________________________________________________

____________________________________________________________________________________________

 Was parent contacted? ________________________ Which parent? _____________________________________

Who contacted parent?__________________________________________________________________________

Time parent was contacted?______________________________________________________________________

Did parent have any special requests as to any action taken?

____________________________________________________________________________________________

________________________________________________________________________________

Provider Signature_________________________________________________________________________________

Date____________________________________________________________________________________________