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26/27 (NEW) First Aid & Medical Incident Report
Please complete the form below in the event of first aid or medical treatment being given. Thank you.
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* Indicates required question
Name of Child:
*
Your answer
Class:
*
RL
RV
1T
1S
2C
2T
3B
3M
4C
4P
5C
5A
6C
6H
Required
Name of staff member who gave treatment:
*
Your answer
Where did the incident occur:
Playground
Field
Classroom
Hall
Other
Clear selection
Please give details of incident:
*
Your answer
Time of incident:
*
Time
:
AM
PM
Nature of injury (please tick all that apply):
*
Graze
Cut
Bump
Bruise
Other
Required
If other, please provide details below:
Your answer
Part of the body where injury occurred eg: front of head, left ankle
*
Your answer
Treatment given (please tick all that apply):
*
Washed/cleaned
Plaster
Ice Pack
No treatment required
Other
Required
If other, please describe here:
Your answer
If temperature was taken, please note it here:
Your answer
Parent/carer to be informed? If yes, please contact parent/carer:
Yes
No
Clear selection
Is a West Sussex accident form required? If unsure, please check with the office:
Yes
No
Clear selection
Submit
Clear form
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