Daycare Incident Report Form

Daycare Incident Report Form

A daycare incident report is used to keep an in-house record of incidents that occur in a daycare facility. It includes the date and time of the incident, a description of what happened, a list of the persons involved, and whether parents and emergency services were contacted. Keeping track of incidents and behaviors helps staff deal with recurring issues and enforce safety standards.

Last updated July 31st, 2025

A daycare incident report is used to keep an in-house record of incidents that occur in a daycare facility. It includes the date and time of the incident, a description of what happened, a list of the persons involved, and whether parents and emergency services were contacted. Keeping track of incidents and behaviors helps staff deal with recurring issues and enforce safety standards.

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Reportable Incidents

  • Medical emergencies
  • Aggressive acts against self or others
  • Unauthorized absences
  • Stolen or damaged property
  • Accidents and injuries
  • Suspected abuse or neglect

Sample

PDF, MS Word, ODT

DAYCARE INCIDENT REPORT FORM
INDIVIDUAL FILING REPORT

Full Name: [FULL NAME] Title/Role: [TITLE/ROLE]
Signature:                                                           Date: [MM/DD/YYYY]

INCIDENT DETAILS
Date of Incident: [DATE OF INCIDENT]      Time: [TIME] AM PM

Facility Name[FACILITY NAME] Location: [LOCATION]

Describe the Incident: [DESCRIBE THE INCIDENT]

PARTIES INVOLVED
Full Name: [FULL NAME] Age: [AGE] Phone: [PHONE] E-Mail: [EMAIL] Address: [ADDRESS]

INJURIES
Was anyone injured? Yes No If yes, describe the injuries: [INJURY DESCRIPTION]

PARENT/GUARDIAN NOTIFICATION
Was the parent/guardian notified? Yes No

Name of person who contacted parent/guardian: [NAME OF PERSON]

Staff person in charge at time of incident: [NAME OF STAFF PERSON]

WITNESSES
Were there witnesses to the incident? Yes No

If yes, enter the witnesses’ names and contact info:

Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL]

POLICE/MEDICAL SERVICES
Police Notified? Yes No

If yes, was a report filed? Yes No

Was medical treatment provided? Yes No Refused

If yes, where was medical treatment provided? On site Hospital Other: [OTHER]

OFFICE USE ONLY
Report received by: [FULL NAME]

Signature:                                                           Date: [DATE]

Follow-up action taken: [FOLLOW-UP ACTION TAKEN]