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ACCIDENT / INCIDENT RECORD

Child’s Name:

Time and date of accident/incident:

Place accident/incident occurred:

Time parent notified of accident/incident:

Description of how the accident/incident occurred:

           

Record of injury:

     

Action(s) taken:

     

Date notified to Ofsted (if child required emergency medical treatment):

Name of witness:

Telephone number:

Address:

Signature:

Childminder Signature:- Mary O’Donahue ______ Date:- 20/3/15

Parent Signature:- Tina Shaw_______Date:- 20/3/15