Accident/Incident/Illness Report Form

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Was this an incident you witnessed?
Date / Time (to the nearest 15 minutes)
Location and details of accident/incident/illness
What kind of first aid was applied?
Location of incident
Where in or out of the school did this occur? e.g. the trim track in the main playground, or in Phoenix Class by the reading area.
In this section, if an injury occurred, be specific with which part of the body was affected (e.g. right hand index finger, or bruise to the left cheek).
Do you need to inform the school office?
Tap Yes if the pupil suffered a head injury, has a high temperature, has had an asthma attack, a major bump, bruise, cut or graze, has vomited, has compromised movement as a result of a sprain or twist, has a loose or missing tooth as a result of impact, or if they have had diarrhoea. If you know the pupils' usual class teacher is not with them and will therefore not receive the email notification, tap yes so the office can inform their cover teacher. If you are not sure whether to inform the office, tap yes.