Accident Report of Student Injury at School
Parent's Phone Number:_______________________________________________________________________________
Alternate Parent's Phone Number:________________________________________________________________________
Name of Student:_____________________________________________________________ Grade_______________
Address:____________________________________________________________________________________________
Date of Incident:______________________________________________________________________________________
Location of Incident:___________________________________________________________________________________
Please write a brief description of what occurred:
Please list any eye witnesses to the incident (attach their statements, if any, to this report):
Please indicate what procedure was taken to resolve the incident:
___________________________________________ _____________________________________________________
Date Signature
_______________________________________________________
Title
Accident reports will be completed and returned to the office of the respective principal within 24 hours of the incident by employee witnessing any event involving injury to a student. The superintendent will receive a copy of the report of any incident involving need for doctor's care or hospitalization. Reports will be kept in the office for the year and then filed in the student's cumulative folder.