# Incident and accident report

Source: https://backpr.com/resources/templates/incident-and-accident-report. Last updated: 2026-10-19.

A staff form for recording injuries, illnesses and behavior incidents the same day: what happened, first aid given, who was told and what you'll change.

Free download: PDF https://backpr.com/media/templates/backpr-incident-and-accident-report.pdf · Word https://backpr.com/media/templates/backpr-incident-and-accident-report.docx

> Fill this out the same day as any injury, illness or incident, and give it to [director's name] before you leave. Write only facts: what you saw, heard and did. Don't use this form for suspected abuse or neglect. Report it as you were trained and tell [director's name] right away.

**Type of incident**
Check all that apply.
- [ ] Injury
- [ ] Illness
- [ ] Allergic reaction
- [ ] Behavior or conflict
- [ ] Missing child or child left the area
- [ ] Property damage
- [ ] Other

**Child**
- Full name: ______
- Age: ______
- Program and group: ______

**When and where**
- Date: ______
- Time: ______
- Exact location (for example, playground near the slide): ______
- Activity at the time: ______
- Staff in charge of the group: ______

**What happened**
Describe it step by step. Write what you saw and heard, not guesses about why.
- What happened: ______
- What happened (continued): ______
- Other staff or adults who saw it: ______
- Other children involved (leave their names off any copy given to a family): ______

**Injury or illness**
- [ ] Head, neck or back involved (call the parent right away, even if it seems minor)
- [ ] Called 911
- [ ] Child went to a doctor or hospital
- [ ] Child went home early
- [ ] Child stayed in the program
- What you saw (such as swelling, bleeding or a bump) and where on the body: ______
- First aid given, by whom and when: ______
- Medicine given (name, dose, time and who gave it): ______

**Who was told**
- Parent or guardian told by (name), how and when: ______
- Director told (time): ______
- Report to the licensing agency or insurer, if required (who, when and by whom): ______

**Follow-up**
- What we'll change to help keep this from happening again: ______
- Follow-up with the family (date and notes): ______

**Signatures**
- Staff printed name: ______
- Staff signature and date: ______
- Director signature and date: ______
- I received a copy of this report. Parent or guardian signature and date: ______

### How to use it
- Keep blank copies in every first aid kit and field trip bag.
- Fill it out the same day, while memories are fresh. If you change anything later, initial and date the change.
- Read through reports each month to spot patterns, such as one spot on the playground or one time of day.
- Check your state's licensing rules for which incidents you must report to the licensing agency, and how fast. Your insurer may have its own deadlines.

**What's the difference between an incident report and an accident report?**
An accident report usually covers injuries, and an incident report covers everything else, such as behavior, illness or a child leaving the area. Most youth programs use one form for both so staff don't have to choose.

**Do we have to give parents a copy of an incident report?**
It's good practice to tell the family the same day and give them a copy or summary. Some states require it for injuries, so check your state's licensing rules. Leave other children's names off the family's copy, and keep the signed original in the child's file.

Free to use and change, but not legal or medical advice. Check your state's licensing rules and your insurer's requirements, and have a lawyer review any consent or waiver language.