Watcombe
Children’s Centre Nursery
Watcombe Children’s Centre
Accident
form / Incident form
Basic
details
Name
of child__________________ Date of
birth______________
Date __________________ Time
______________
Details
of accident
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
First
Aider _______________
Action
taken
________________________________________________________________________________________________________________
Witness
signature __________________
Number of staff present ____
|
Bump |
Bruise |
Cut/ graze |
Nosebleed |
Vomiting |
Head Injury |
High Temperature |
Asthma |
Other |
|
|
|
|
|
|
|
|
|
|
Follow
up action / recommendation
__________________________________________________________________________________________________
_________________________________________________
Parents
contacted by phone Date___________ time__________
Parent’s
signature _____________________ date_________
Key
person signature____________________
date ________
Managers signature_____________________ date _________
Date
reviewed
By
H & S Officer ______________
H
& S officer’s name _______________