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Appendix B - Incident /Accident Report

All information about incidents and accidents should be recorded on the attached Incident/ Accident report form:
Date and time of the incident

Date:

Time.........................................

Weather conditions.............................................................................................................................
Location of incident.............................................................................................................................
Description of incident.........................................................................................................................

................................................................................................................................................................
................................................................................................................................................................
Equipment/area involved......................................................................................................................
................................................................................................................................................................
Contributing factors if known................................................................................................................
................................................................................................................................................................
If the incident involved injury the following information should also be recorded in writing:
Child/Educator/parents details
Last Name.........................................................First Name....................................................................
Details of the injury sustained...............................................................................................................
...............................................................................................................................................................
Person/s notified - time and date of notification
Parent/ Nominated Educator........................................................ Date:

Director/Principal/Coordinator.............................................. Date:

Time.....................
Time.....................

Initial treatment...................................................................................................................................
................................................................................................................................................................
................................................................................................................................................................
Subsequent treatment (if known).........................................................................................................
................................................................................................................................................................
Corrective action/repair/maintenance recommended........................................................................
...............................................................................................................................................................
Date corrective action completed:

Director/Principal/Coordinator:

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