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
- New Jersey asks for a record of each injury it lists (a bite that breaks the skin, a head or face injury, a fall from higher than the child, anything needing medical care): the child, the date, time and place, the center's name and address, who wrote it and when, what happened, the injury, the witnesses, and the first aid and any medical care. Parents are told at once for those, and by the end of the day for other bites and injuries (N.J.A.C. 3A:52-7.6).
- Maine asks for a same-day record of every injury, accident and incident, showing when the parent was told, and the parent's signature: within 48 hours in the records section, within two business days in the health section (10-148 CMR Ch. 32 §5(D)(n), §12(F)(2)). Getting it signed within 48 hours meets both.
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