Free templateAdministration

Accident / Incident Form

A one-page accident and incident report to complete in ink: what happened, where, how many children were in the room, where staff were, first aid given and follow-up, with lines for parent notification and director and parent signatures.

Format: Printable PDF · US Letter
Pages: 1
Best for: All staff · directors
Updated: Sept 2026

Download free template See what’s inside

No sign-up required. Print it and share it with your team — it’s free for any child care program to use.

What’s inside

What happened, what staff did, and who was told

Child, date and timeChild’s first and last name, plus the date and time of the accident or incident.
What happened and where‘What was the Accident / Incident?’, Location of Occurrence, # of Children in the Room and Location of Staff, followed by a larger Description of Occurrence box.
First aid and staff actionsA First Aid Administered box beside a ‘Staff Actions by’ line for the staff member’s name.
Comments and follow-upA Comments box for recommendations, corrective actions and follow-up.
Notification and signaturesStaff initial whether the parent was notified immediately or at departure, and whether another child’s parent was notified in writing or verbally. Signature lines for the director and parent, each with a Day/Month/Year date.

How to use it

Four steps to put it to work this week

1
Attend to the child firstFirst aid, comfort, and a second adult covering ratio — the form waits.
2
Write it the same day, in inkFacts only, in the order they happened: what, where, how many children were in the room and where staff were. No opinions about fault.
3
Tell the family in personAt pick-up, or by phone before pick-up if it is significant. Initial ‘Immediately’ or ‘At departure’ on the form, then get the parent’s signature.
4
Log it and look for patternsFile in the child’s record and your incident log. Three incidents at the same slide is a slide problem.

Tips from operators

What centers that use this well do differently

Learned the hard way across 3,000 child care spaces — and from the directors and educators who join our Lunch & Learns and Learning Labs.

Describe the injury precisely

The form has no body diagram, so write exactly where and how big — ‘2 cm scrape, left knee’ — in the description box. It protects you if a bruise is questioned later.

Know your ‘serious occurrence’ threshold

Every province and state defines what must be reported to licensing and how fast. Print that rule on the back of the form.

Keep incident reports out of the classroom binder

They contain personal health information. File them in the child’s secured record, not on the shelf.

Do it digitally in ChildFriendly Pro

Custom checklists and forms, time-stamped and filed for inspection

Build any checklist or form once in ChildFriendly Pro, assign it to a room or role, and every completion is time-stamped, signed and filed in your inspection binder — ready for licensing or public health.