Daycare Injury Incident Log PDF

Record injuries, witnesses, and care given at daycare to keep parents and providers aligned.

Daycare & child details

Capture injuries, witnesses, and care provided to keep daycare staff and parents aligned.

Child name

Parent / Guardian (optional)

Daycare name

Daycare address (optional)

Phone (optional)

Email (optional)

Incident report # (optional)

Pediatrician or clinic (optional)

Log the date, injury, and care provided.

Incident 1

Date

Time (optional)

Location in facility (optional)

Injury description

Reported by (optional)

Witnesses (optional)

First aid or care given (optional)

Photos / evidence (optional)

Follow-up notes (optional)

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