Accident Form
Please complete all sections of this form and notify a manager regarding this accident
Child's name *
Child's date of birth *
Your name *
When did the accident occur *
At what time? *
Use 24 hour clock please, so for example 2pm is 14:00.
Where did the accident occur? *
Please state exact location
What happened? *
Please state exactly what happened, and including details of any marks/bumps. I.e. exact location on body, shape, size (5p piece, 2cm by 1cm), colour or marks
What action did you take? *
i.e. cold compress, cuddle etc
Did this accident involve a head injury? *
Signs of a concussion usually appear within a few minutes or hours of a head injury.But occasionally they may not be obvious for a few days, so it's important to look out for any problems in the days following a head injury. Symptoms include:a headache that doesn't go away or isn't relieved with painkillers dizziness feeling sick or vomiting, memory loss – you may not remember what happened before or after the injury, clumsiness or trouble with balance, unusual behaviour – you may become irritated easily or have sudden mood swings, feeling stunned, dazed or confused, changes in your vision – such as blurred vision, double vision or "seeing stars"being knocked out or struggling to stay awake. Concussion can be harder to spot in babies and young children. One of the main things to look for is a change in their normal behaviour after a head injury, such as crying a lot, a change in their feeding or sleeping habits, or a loss of interest in people or objects. (Taken from Please seek medical attention if your child shows any of the above sypmtoms following a head injury.
Never submit passwords through Google Forms.
This form was created inside of Rainbow Nursery. Report Abuse