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Audit

Incident Details
Date and Time of Incident

What was the incident/ near miss?

Were there any injuries?

Please identify injured person(s)

Was there any damage to daycare property?

What caused the incident?

Take photos of surrounding environment and include any annotations

Medical Services/Treatment Provided (Please include any and all treatment, listing who administered treatment)

What actions will be taken to eliminate future repeats of the incident?

Teacher's comment(s)

Sign Off

Witnesses of the incident

Witness
Witness' Full Name and Signature
Medical Personnel
Teacher's Full Name and Signature

Daycare Incident Report Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 13

This Daycare Incident Report template can be used to gather necessary facts, photo evidence and general information of any possible incident that may occur in the daycare. Use iAuditor to instantly generate reports and send copies to parents. Feel free to modify this template to suit your daycare needs.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

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Audit

Incident Details
Date and Time of Incident

What was the incident/ near miss?

Were there any injuries?

Please identify injured person(s)

Was there any damage to daycare property?

What caused the incident?

Take photos of surrounding environment and include any annotations

Medical Services/Treatment Provided (Please include any and all treatment, listing who administered treatment)

What actions will be taken to eliminate future repeats of the incident?

Teacher's comment(s)

Sign Off

Witnesses of the incident

Witness
Witness' Full Name and Signature
Medical Personnel
Teacher's Full Name and Signature