Daycare Incident Report Checklist

This incident reporting form can be used to gather necessary facts, evidence and general information when an incident has occured in a daycare centre.

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Daycare Incident Report Checklist

Incident Details

Witness

Incident Details

Witness

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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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Daycare Incident Report Checklist

This incident reporting form can be used to gather necessary facts, evidence and general information when an incident has occured in a daycare centre.

1. Date of incident

2. Time of incident

3. What was the incident/ near miss incident?

4. Were there any injuries?

5. Was there any damage to property?

6. What caused the incident?

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

8. What actions will be taken to eliminate future occurrences of the incident?

9. Teacher's comment(s)

1. Witness' full name

2. Witness report / comments of the incident

3. Medical personnel details

4. Medical personnel comments

1. Date of incident

2. Time of incident

3. What was the incident/ near miss incident?

4. Were there any injuries?

5. Was there any damage to property?

6. What caused the incident?

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

8. What actions will be taken to eliminate future occurrences of the incident?

9. Teacher's comment(s)

1. Witness' full name

2. Witness report / comments of the incident

3. Medical personnel details

4. Medical personnel comments