Child Care Incident Report PDF Details

Child care incident reports provide a great opportunity for parents to get insight into how their child interacted with the daycare staff and other children. It is important that all incidents be recorded so that we can better understand what needs improvement in our childcare centers. This blog post will cover different types of issues and what you should do if it happens to your child. A child care incident report is a form completed by caregivers when something occurs during the day at the center such as an injury, illness, or other type of event. These reports allow parents to review their child's behavior and learn more about his or her experience at the daycare facility.

Listed here, there are a number of particulars about child care incident report PDF. It can be useful to find out its size, the average time to prepare the form, the fields you'll have to fill in, and so on.

Form NameChild Care Incident Report
Form Length1 pages
Fillable fields45
Avg. time to fill out9 min 19 sec
Other namesdaycare incident report pdf, child care incident report pdf, incident report template childcare, daycare incident report form

Form Preview Example

Child Care Injury/Incident Report

Child’s Name:

In addition to reporting to the department by phone or email about the following incidents and injuries,

a provider must also complete this incident report and submit it to DCYF within 24-hours.

Provider Name



Provider ID







Child’s Age

Date of Incident

Time of Incident

Incident Occurred




a.m. p.m.







List names of staff present and/or witnesses:

Treatment provided to child while in care & by who:






Check All That Apply

Situation that required an emergency response from:

Emergency services (911)

Washington poison center

Department of Health




Situations that occur while children are in care that may put children at risk including, but not limited to:

Inappropriate sexual touching

Physical abuse









Serious injury to a child in care:

Severe bleeding

One or more broken bones

Choking or serious unexpected breathing problems

Severe neck/head injury

Sudden unconsciousness

Dangerous chemicals in eyes, on skin, or ingested

Near drowning

Shock or acute confused state

Severe burn requiring professional medical care


Overdose of chemical substance

Injury resulting in overnight hospital stay

Please give a brief description of the injury/incident, including where it occurred.


Parent/Guardian Contacted




Licensor Contacted





In Person





In Person













Parent/Guardian Comments:

Parent/Guardian Signature


By signing this form, I acknowledge that I received a copy of this report.

Licensee/Staff Signature



Copiesto: Parent, licensor, licensee

DCYF 15-941 (REV. 6/2021) EXT


How to Edit Child Care Incident Report Online for Free

Managing files along with our PDF editor is easier as compared to most things. To change incident report for daycare the form, there's nothing you should do - merely continue with the steps down below:

Step 1: Press the button "Get form here" to get into it.

Step 2: At the time you get into our incident report for daycare editing page, you'll see all of the options it is possible to take with regards to your form in the top menu.

The next sections will make up the PDF file that you will be creating:

step 1 to filling in childcare incident report

Type in the required details in the section Situation that required an, Maltreatment, Physical abuse, Neglect, Exploitation, Inappropriate sexual touching Other, Serious injury to a child in care:, Severe bleeding Severe neck/head, One or more broken bones Sudden, Choking or serious unexpected, Please give a brief description of, Parent/Guardian Contacted, E-mail, Phone, and In Person.

Filling in childcare incident report step 2

You can be requested to write down the particulars to let the system fill out the box Date: Time: Parent/Guardian, Date, Licensee/Staff Signature, Date, CHILD CARE INJURY/INCIDENT REPORT, and Copies to: Parent.

Finishing childcare incident report stage 3

Step 3: Press the "Done" button. Now, you may transfer your PDF file - download it to your electronic device or send it via electronic mail.

Step 4: Generate copies of the form - it can help you keep away from forthcoming challenges. And don't get worried - we do not distribute or look at your information.

Watch Child Care Incident Report Video Instruction

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