Calvary Christian School
Accident Report/Incident Report
Accident Report/Incident Report
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Type of Report
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Accident
Incident
Student Name
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Student Age
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Preschool
Elementary
Middle School
High School
General Time of Accident/Incident
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Regular School Hours
Extended Care
Summer Care
Date of Accident/Incident
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Specific Time of Accident
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Type of Accident/Incident
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Bump/Bruise
Cut
Bite
Scratch
Punch.Hit/Push
Scooter Related
Collusion
Fall/Trip
Nose Bleed
Location
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Classroom
Gym
Playground
Bathroom
Lunchroom
Hallway/Other
Supervising Teacher/Staff
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Description of what happened
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Was the student injured?
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Yes
No
Explain the nature of the injury
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Was first aid administered?
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Yes
No
If yes, by whom?
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Was parent/guardian notified?
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Yes
No
If yes, by whom?
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Was the student taken to the emergency room?
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Yes
No
If yes, by whom?
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This report was prepared by
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Date report prepared
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* required
