ACCIDENT / INCIDENT RECORD

Child’s Name:-

Time and date of accident/incident:-

Place accident/incident occurred:-

Time parent notified of accident/incident:-

Description of how the accident/incident occurred:-
 
 
 
 
 
 

Record of injury:-
 
 
 

Action(s) taken:-
 
 
 

Date notified to Ofsted (if child required emergency medical treatment):

Name of witness:

Telephone number:

Address:

Signature:

Childminder Signature:- Mary O’Donahue ______ Date:- 20/3/15

Parent Signature:- Tina Shaw_______Date:- 20/3/15