Overview

Use this Injury Report form to document serious injuries that occur in your early learning setting. This form is for reporting things like major cuts, head trauma, burns, and dental or eye injuries.

Use our Minor Injury Notification form for reporting the common minor bumps, bruises, scratches, scraps, and cuts that occur as part of developmentally appropriate active play.

Using The Injury Report Form

Here’s an overview of how to use this form:

General Information

In this section, you enter general information:

• Child’s name and age
• The date and time of the incident
• What happened
• Who informed the child’s parent
• Who witnessed the incident
• Who notified the parent and when notification was made

Type Of Injury

In this section, you check the type of injury. Twelve types of injuries are listed, or you can check the Other box and describe the type of injury.

How Injury Occurred

In this box, provide a detailed description of what happened.

Injury Location

On the diagrams, mark the location of the injury and provide any related notes or details.

Treatment

Describe the treatment that was administered and actions taken after the injury. Include relevant comments and notes.

Signatures

Finally, the person completing the form should sign it and signatures of the child’s parent and the program director should be added. Copies can then be filed and distributed as required in your program.

Here’s The Free Injury Report Form

Download it, print it, and use it to help keep everyone in your setting safe and healthy:

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