Accident Report
Name of child:
Date:
Time:
How the accident happened:
Type of injury:
Age of child:
Location:
Position of Injury
Type of first aid administered:
Who administered first aid:
Who Witnessed the Accident:
Parents were notified of the accident by:
Is any further action needed:
Nurse/First Aider’s signature:
Manager/Coordinator’s signature:
Parent’s signature:
Tel:
Report:
Date:
Date:
Date:
A copy of this accident report must be sent home with the parent and the original must be
placed in the child’s medical file.
Office 2606 | Tameem House | Barsha Heights | Dubai | Tel: 04 27 66 737 | Email: [email protected] | Website: www.eyes-me.com