SafetyCulture Staff

Daycare Incident Report

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 SafetyCulture to instantly generate reports and send copies to parents. Feel free to modify this template to suit your daycare needs.

Use this Template

Print as PDF

Use this Template

Go digital today!

Convert your paper checklists into digital forms

Scan this QR code to use this paper checklist on your smartphone or tablet or visit https://safetyculture.com/

Title Page

Student / Child's Full Name
Conducted on (Date and Time)
Teacher's Full Name

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

SafetyCulture Staff

Daycare Incident Report

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.