The Childcare Incident Report Form must be completed by the provider and/or the designated representative of the provider.
What is the date of the incident?
What time did the incident occur?
Where did the incident occur?
Nature of Injury
Please specify in detail what really happened.
Was the child taken to the hospital?
Who witnessed the incident?
Name of caretaker incharge:
What was the treatment given?
Were the parents informed about the incident?
What disciplinary action was taken?
What could've been done to prevent the incident?