School Accident Report Form

School Accident Report Form

Please fill out this form to provide details about the accident.

Accident Details

Date and Time of Accident

    Location of Accident

      Description of Accident

        Student Involved

        Name

          Grade Level

            Grade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12

            Were any injuries sustained by the student?

            If yes, please describe the injuries

              Action(s) Taken

              Select all that apply:

                • First Aid Administered

                • Called Parent/Guardian

                • Emergency Services Contacted

                Reported By

                Name

                  Job Title

                    Name:

                    Date:

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