Printable Blank Incident Report
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Download Printable Blank Incident Report
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Do you have an idea of what you want to draft, but you cannot find the exact words yet to write it down or lack the inspiration how to make it? If you've been feeling stuck, this Printable Blank Incident Report template can help you find inspiration and motivation. This Printable Blank Incident Report covers the most important topics that you are looking for and will help you to structure and communicate in a professional manner with those involved.
climber, toy, swing, etc.) Cause of Injury: Fall to surface estimate height of fall type of surface depth of surface Fall from running or tripping Motor Vehicle Hit or pushed Pinched by: Bitten by: Injured by object equipment person human Cut Slipped animal Insect sting/bite Eating or choking Unknown/not witnessed Other (specify): Describe Incident Type of Injury (ies): (check all that apply) Bite was skin broken Yes No Burn Bump Scratch Crushing injury Skinned/Scrape Nose Bleed Sprain/Strain Sliver Broken bone Bruise or swelling Puncture Other (specify): Sting Loss of consciousness Location of Bodily Injury (ies): (check all that apply) Head Trunk Arm R L Leg R L Scalp Neck Arm Face Collar Bone Elbow Ankle Ear Ear Wrist Foot Eye Chest Eye Knee Nose Stomach Thumb Mouth Buttocks Finger Toe Other (specify): Teeth Genital Area Tongue Shoulder: Lip Other (specify): Leg Other (specify): R L Forehead Describe Injury Describe Action Taken Was medical attention (at hospital or clinic) required Yes No Reminder - The provider shall report within twenty-four hours to the county director or the county director s designed a death or serious accident or illness requiring hospitalization of a child while in the care of the facility or attributable to care received in the facility..
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