Fill and Sign the Accident Report 497330969 Form

Child Care Accident Report Child’s Name:       Date of Accident:       Time of Accident:       Nature of Injury:       Location of Incident:       What the child was doing:       Caregiver response and first aid:             Name of Caregiver that responded:       Additional Information:       Parent contacted? Yes No Name of Parent contacted:       Who contacted parent:       How parent was contacted: Phone Email Other: Time parent was contacted:       Other Contacts or Actions:             (Name of Child Care Employee) By: (Signature of Employee)       (Title with Organization) Date:       Child Care Accident Report Page 1 of 1