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.
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
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
- 1Attend to the child firstFirst aid, comfort, and a second adult covering ratio — the form waits.
- 2Write 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.
- 3Tell 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.
- 4Log 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.
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.
- Form builder for checklists, incident and medication forms
- Assign by room, role or schedule with reminders
- Inspection binder export in one click
FAQ
Questions about the Accident / Incident Form
Can’t find your answer? Chat with a real person who has run a child care center.
Read more FAQsWhen must an incident be reported to licensing?
Each jurisdiction defines ‘serious occurrences’ — typically injuries needing medical attention, missing children, allegations of abuse, or emergency service involvement — with a 24-hour or same-day deadline. Check your regulation and note the contact on the form.
Does the family have to sign?
Best practice and often a licensing expectation: the family signs to acknowledge they were told. If they refuse, note that on the form.
How long do I keep incident reports?
Follow your record-retention rule — commonly the length of enrolment plus several years, and longer for serious occurrences. Store them with the child’s file, not in the room.
Can this be done digitally?
This download is a print-and-handwrite PDF — it is not fillable and is meant to be completed in ink. If you want a digital process, child care platforms like ChildFriendly Pro capture incident reports with parent e-signatures and file them into the child’s record automatically.
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