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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.
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Daycare Incident Report Form

(page name not set)

Audit

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

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