Lumiform Mobile audits & inspections
Get App Get App

Daycare Incident Report Form

This daycare incident report template can be used to gather necessary facts, photo evidence and general information of any possible incident that may occur in the daycare. Use Lumiform to instantly generate reports and send copies to parents. Feel free to modify this template to suit your daycare needs.

Downloaded 21 times
Incident Details
Date and Time of Incident
What was the incident/ near miss?
Were there any injuries?
Please identify injured person(s)
Was there any damage to daycare property?
What caused the incident?
Take photos of surrounding environment and include any annotations
Medical Services/Treatment Provided (Please include any and all treatment, listing who administered treatment)
What actions will be taken to eliminate future repeats of the incident?
Teacher's comment(s)
Sign Off
Witnesses of the incident
Witness' Full Name and Signature
Medical Personnel
Teacher's Full Name and Signature
Share this template:

This post is also available in: Español

Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
This site is registered on as a development site. Switch to a production site key to remove this banner.