School Accident Report Form PDF Details

When a school-aged child is injured, it is important to make sure the correct paperwork is filed with the school administration. The School Accident Report Form can help make this process easier. This form can be used to report any type of injury that occurs while at school. It includes information on how the injury happened, what treatment was given, and contact information for parents or guardians. Having this form handy can help ensure that all necessary information is collected in case of an accident.

You will find info about the type of form you need to submit in the table. It can show you how much time it will require to complete school accident report form, what parts you will have to fill in, and so on.

QuestionAnswer
Form NameSchool Accident Report Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesaccident form template for schools, school accident report, accident report for accident that happen at school, example of a report about accident at school ground

Form Preview Example

THE SCHOOL BOARD OF POLK COUNTY

STUDENT ACCIDENT REPORT FORM

Name ____________________________ Home Address _________________________________________________

School ____________________________________________________ Sex:

M F Age: _____ Grade ________

Time Accident Occurred: Hour ________ A.M. ________ P.M.

Date __________________________________

Place of Accident: School Building _____ School Grounds _____

To or From School ________

DESCRIPTION OF THE ACCIDENT

List student activity at time of accident, location on campus of accident , list any equipment, tool, or machinery that was

involved. Describe in detail the events leading up to the accident, and the accident itself:

____________________________________________________________________________________________________

________

____________________________________________________________________________________________________

________

____________________________________________________________________________________________________

________

____________________________________________________________________________________________________

________

ADDITIONAL INFORMATION

Teacher in charge when the accident occurred ______________________________________________________________

Present at the scene of accident ____ Yes ____No

Direct Blood Contact ____Yes ____ No Persons involved __________________________________________________

First Aid Treatment _____ By (Name)

___________________________________________________________________

Sent to School Nurse ____ By (Name) ___________________________________________________________________

 

Sent Home

_____ By (Name)

 

____________________________________________________________________

Sent to Physician

_____ By (Name) ___________________________________________________________________

Physician’s Name: ___________________________________________________________________________________

Sent to the Hospital ____ By (Name) ___________________________________________________________________

Was a parent or other individual notified? ____ Yes ____ No When? __________ How?

_________________________

Name of individual notified: ___________________________________________________________________________

By whom? (Enter Name) ______________________________________________________________________________

Witnesses: 1. ______________________________________ 2. ____________________________________________

3.______________________________________ 4. ____________________________________________

REMARKS

In all occurrences of direct blood contact, persons involved or responsible persons should be informed that confidential

information concerning HIV and Hepatitis is not available from or through Polk County Schools.

Principal ___________________________ Date ________ Teacher __________________________ Date _________

Watch School Accident Report Form Video Instruction

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