Accident Record Form

This form should be filled out by the class teacher if a student has an accident or is injured during their class. The form should be filled in as soon as possible after the class is ended and appropriate actions to manage the incident have been taken.

Student Name

First Name

Last Name

Date of incident

YYYY

Time of incident (approximate)

Description of incident

Describe what happened

Actions taken

Explain what you did to manage the incident

Teacher Name

First Name

Last Name