Incident / Accident Report

Complete the same day as the incident. Give one copy to the parent and keep one on file.

Wylari

Child's name

Date of birth

Classroom / group

Date of incident

Time

Location (room, playground, etc.)

Staff present / witnesses

Type of Incident

Injury / accident Illness Behavior Bite Fall Allergic reaction Other:

What Happened

Describe what happened, what led up to it, and how staff responded. Stick to facts.

Injury & Care

Body part(s) affected

Nature of injury (bruise, scrape, bump, etc.)

First aid provided

Medical attention required? No Yes — describe:

Parent Notification

Notified by (staff member)

Method (in person, phone, message)

Date / time notified

Follow-Up

Steps taken to prevent this in the future (if applicable)

Signatures

Staff member completing report

Date

Director / provider review

Date

Parent / guardian acknowledgment

Date

Free daycare template from Wylari — simple software for in-home daycares & small centers wylari.com/templates