Free printable incident and accident report.

Fill one in when a child is hurt or gets sick in care. Use it too when the family should know about something.

It prints at the top of the form.

Incident and accident report

Program
Child’s name
Child’s date of birth
Room or group
Staff present

When and where

Date
Time
Where it happened

Kind of incident:InjuryIllnessBiteFallBehaviorOther

What happened

What happened, in order
Injury, if any: the body part and what it looked like
First aid or care given
Care given by
Time care was given

Who was told:FamilyDirectorDoctor911Licensing office

Telling the family

Family member told
How they were told
Date and time told
Steps taken so it does not happen again

Signatures

Staff who wrote this report
Date
Director
Date
Family member
Date

Free printable form from bloomily.app/tools/forms

How to use this form

  1. Write the report as soon as the child is safe and cared for.
  2. Describe what you saw. Leave out guesses and blame.
  3. Tell the family the same day, and ask them to sign.
  4. Give the family a copy, and file the original in the child’s record.

Check your state’s rules

States decide which incidents must also go to the licensing office, and how fast. Check your state’s rules, and keep its reporting number by the phone.

Find your state’s licensing page

Do this in Bloomily

In Bloomily, staff write up an incident with photos and the first aid given. The family reads it in the parent app and taps to say they saw it.

See health and safety

More free forms

Questions, answered

When should we fill in an incident report?

Any time a child is hurt or gets sick in care. Also when something happens that the family should know about. Write it the same day.

Does the family need to sign it?

Most programs ask for a family signature to show they were told. Some states require it. Give the family a copy.

See it with your name on the door.

Get started

or book a demo

One flat price per location, never per child. $199 a month billed yearly ($2,388), or $249 month to month. Free for home daycares up to 18 children. Every fee is on the pricing page.

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