Student Accident Report
To be completed by an Employee when a student is injured on school grounds or at a school activity.
Email address *
Person Completing the form *
Your answer
Student *
Your answer
Student Grade *
Date of Accident *
MM
/
DD
/
YYYY
Time of Accident *
Time
:
Building *
Location *
Your answer
Problem *
Your answer
Was the student sent to the School Nurse? *
What treatment did the student receive?
Your answer
Was First Aid Given? *
Explain what happened? *
Your answer
Was the parent notified *
Was the parent notified? How?
Your answer
Did the student seek medical attention *
If yes, name Hospital/Doctor (if known)
Your answer
Was the student absent from school because of the injury? *
If so, how many days
Your answer
Was a teacher or supervisor on duty at the time of the accident? *
If so, who?
Your answer
A copy of your responses will be emailed to the address you provided.
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