0/800
0/400

Print Preview

Confidential record

Center Notes Suite

CONFIDENTIAL

Incident / Accident Report

ID: IR-20260530-0042
ChildSofia
Date of Birth-
ClassroomButterfly
Date / Time of IncidentToday, 10:15 AM
Location of IncidentPlayground
Incident ClassificationMinor Injury
Severity LevelLevel 2 - Low
1. Incident Description & Body Parts Affected

Sofia tripped on the playground surface...

Area affected: Left knee

Discovery Source: Witnessed by staff

2. Response, Actions & First Aid Applied

Teacher James comforted Sofia...

3. Witnesses Present

Staff: James, Ana

Children: -

Other: -

4. Parent / Guardian Notification

Parent/Guardian has not been notified yet.

Reported By Teacher James Lead Teacher
Director / Supervisor Ms. Chen
Filing Date Today
Educator Signature Date: _______________
Parent/Guardian Signature Date: _______________