Farlow

Free template

Incident and injury report

A child's injury at the center needs a written record the same day and a parent who knows about it. This form has the fields two states list in their rules, so one sheet covers what an inspector looks for.

What the rules ask

Your state may have its own form. New Jersey, Maine and others publish one; if yours does, use it. This sheet is for a center that has none.

Incident and injury report

Center
Center address
Child
Date
Time
Where it happened

What happened

The injury (where on the body, what it looks like)

Witnesses

First aid given, and by whom

Medical care (who, when), if any
Parent told by
How (call, in person, app)
Date and time parent was told
Report written by
Date written
Parent signature
Date signed

Or write it in Farlow and send it to the family

Teachers write the report in Farlow and send it to the family in the app, through the office first if your center reviews reports. The family's acknowledgment is kept with the report.

How it works
Get Farlow for your center