Free Daycare Incident Report Form Template
Daycare Incident Report Form
Please fill out this form to document any incidents that occur during daycare hours.
Child's Information
Name
Date of Birth
Parent/Guardian Name
Phone number
Incident Details
Date and Time of Incident
Location of Incident
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Playroom
-
Playground
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Classroom
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Description of Incident
Please provide a detailed account of what happened
What actions were taken in response to the incident?
Witnesses (if any)
Please list any staff members or other children who witnessed the incident
Parent/Guardian Acknowledgment
I acknowledge that I have been informed of the incident and understand the actions taken.
Name:
Date:
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