Daycare Accident Report
Accident Report
Child's Name __________________________________________________________________
Date Accident occured _______________ Time Accident occured _________________
Injury Description __________________________________________________________________
What was child doing when the accident occured _________________________________
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First aid applied ______________________________________________________
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Additional Information __________________________________________________________________
__________________________________________________________________
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Was parent contacted _______ Which parent __________________________________
Who contacted parent _______________________________________________________
Time parent was contacted ______________________________________________
Special request by parents for action taken?________________________________
__________________________________________________________________
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Provider Signature: ________________________________Date________________
Parent Signature:__________________________________Date________________