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
Date of Accident/Incident
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Specific Time of Accident/Incident
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Location
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Classroom
Gym
Playground
Bathroom
Lunchroom
Hallway/Other
Teacher/Staff Preparing the Report
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Description of what happened
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Was the student injured?
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Yes
No
What first aid was administered and 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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* required
