undefined

Childcare Incident Report Form

The Childcare Incident Report Form is used by childcare providers to report any incidents that occur while children are in their care. This form can be used to report any type of incident, including but not limited to accidents, injuries, fights, bullying, property damage, and disruptive behavior. This form can also be used to report any incidents of suspected child abuse or neglect.

3 minutes to complete

Eligibility

The Childcare Incident Report Form must be completed by the provider and/or the designated representative of the provider.

undefined

Questions for Childcare Incident Report Form

Questions

1.

Child's Name

The answer should be a text input.
2.

Age

The answer should be a text input.
3.

Gender

The answer should be a single choice:
  1. Male
  2. Female
4.

What is the date of the incident?

The answer should be a date input.
5.

What time did the incident occur?

The answer should be a text input.
6.

Where did the incident occur?

The answer should be a text input.
7.

Nature of Injury

The answer should be a text input.
8.

Please specify in detail what really happened.

The answer should be a text input.
9.

Was the child taken to the hospital?

The answer should be a single choice:
  1. Yes
  2. No
10.

Who witnessed the incident?

The answer should be a text input.
11.

Name of caretaker incharge:

The answer should be a text input.
12.

What was the treatment given?

The answer should be a text input.
13.

Were the parents informed about the incident?

The answer should be a single choice:
  1. Yes
  2. No
14.

What disciplinary action was taken?

The answer should be a text input.
15.

What could've been done to prevent the incident?

The answer should be a text input.

Forms Similar to Childcare Incident Report Form

  • Daycare Incident Report Form
  • Preschool Incident Report Form
  • Childcare Center Incident Report Form
  • In-Home Childcare Incident Report Form

Here are some FAQs and additional information
on
Childcare Incident Report Form

What information should I include in incident report?

When reporting an incident, you should include as much information as possible. This includes the date and time of the incident, a description of what happened, and the names of any witnesses or victims. If you have any documentation, such as photos or videos, you should also submit these to your provider.

Why should all incidents and accidents be reported?

It is important and necessary to report incidents as they occur. Reporting is not about attributing blame, but more about identifying possible workplace issues so they don't happen again.

What types of incidents should be reported?

All incidents that occur in the childcare centre should be reported, no matter how minor. This includes accidents, near-misses, property damage, and injuries.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Childcare Incident Report Form

1000+ Templates, 50+ Categories

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE