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Run: School Student Injury and Accident Report Form

A School Student Injury and Accident Report Form for recording what happened, who was involved, first aid given, witness details, and parent or guardian noti...

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Submission Notice

Date of Report (required)

Time of Report (required)

Reporter Name (required)

Reporter Role (required)

Incident Location (required)

Date of Incident (required)

Student Information

Student Name (required)

Student ID

Optional if your school uses another unique identifier for record matching.

Grade Level (required)

Was the student under school supervision at the time? (required)

Incident Details

Incident Type (required)

Description of What Happened (required)

Provide a brief factual account of the event, including what the student was doing and how the injury occurred.

Body Part Affected (required)

Injury Severity (required)

Were emergency services called? (required)

Emergency Services Details (required)

First Aid and Medical Response

Was first aid provided? (required)

First Aid Provided (required)

Was the student referred for medical evaluation? (required)

Medical Referral Details (required)

Witnesses and Notifications

Were there witnesses? (required)

Witness Names

List witness names and brief statements only if needed for follow-up.

Was a parent or guardian notified? (required)

Notification Method

Time of Notification

Follow-Up and Review

Immediate Follow-Up Actions

Additional Notes

Does this incident require administrative review? (required)

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Email (required)

Your name (optional)

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