Student Injury Report

Important Compliance & Documentation Reminders:

  • When in Doubt, File a Report: If you are unsure whether an incident or injury warrants a formal report, always err on the side of caution and document it anyway.
  • Do Not Diagnose: Please describe only the objective, observable facts of the injury (e.g., “student reported pain in right wrist,” “visible swelling,” or “1-inch scrape”). Do not provide a medical diagnosis (e.g., do not write “fractured wrist” or “concussion”).
  • Aeries Documentation: Remember to document any and all subsequent medical follow-ups, parent contacts, or status updates directly in the student's Aeries medical log to ensure a complete and permanent record.
  • Timeline: Injury reports must be submitted in no less than 72 hours of when the injury occurred. 
  • Emergency Medical Services: If Emergency Medical Services are required for the injury, please complete section 2 of this report.  If Emergency Medical Services is not required, you may skip section 2 and click "Submit."
  • Please do not use this form for employee injuries.  All employee injuries should be reported through Company Nurse.  The injured employee should work with site/department administration to report injuries.
  • The visitor injury reporting form has moved.  Please click here to access the new form if reporting the injury of a visitor. 

Email *
School Site *
Did this occur during a field trip, or during the ELOP Program?
Clear selection
Brief description of injury location at the school or department  *
Playground, admin office, classroom K-1, etc.
Date of Injury *
MM
/
DD
/
YYYY
Time of Injury *
Time
:
Name of Injured Person *
Student ID (if applicable)
How did the injury occur? *
Please provide a detailed description of how the injury occurred.
Employee with Most Knowledge of Incident
Witnesses Present at Time of Injury (if applicable)
Include age (if student) and phone number
Nature of Injury *
Part of body and type of injury
What type of first aid was applied and by whom? *
Disposition of Injured Person *
Return to class, home, doctor, hospital, ambulance
Have the student's parent/guardian been contacted?
Clear selection
What were the parent/guardian's directives? *
Does the injured student have school insurance? 
Clear selection
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