Audit-ready print checklist
Childcare Incident Report & Documentation Log
Printable incident report form and log for licensed childcare centers. Covers injuries, illness events, near-misses, and parent notification records.
- Confirm attendance dates match room records.
- Mark ratio notes that support licensing review.
- Attach subsidy claim evidence before filing.
- Keep guardian and pickup updates with the child record.
How to Use These Templates
Print the Single Incident Report form and keep a stack accessible in each classroom, the director’s office, and the front desk. Complete a form the same day as every incident. The Weekly Incident Log is for the director’s use to track patterns — complete it at the end of each week by reviewing the week’s individual reports.
Single Incident Report Form
Complete one form per incident. Write legibly. Do not leave fields blank — write “N/A” if not applicable.
INCIDENT REPORT — [CENTER NAME]
Child Information
Child’s Full Name: _______________________________________________
Date of Birth: ___________________ Age: _______ years _______ months
Classroom/Group: _______________________________________________
Teacher of Record: _______________________________________________
Incident Details
Date of Incident: ___________________ Time of Incident: ___________ [ ] AM [ ] PM
Location Where Incident Occurred: [ ] Indoor classroom [ ] Outdoor play area [ ] Restroom [ ] Hallway/common area [ ] Nap area [ ] Other: _______
Type of Incident: [ ] Injury [ ] Illness/Medical [ ] Near-miss [ ] Behavioral [ ] Child missing/elopement [ ] Medication error [ ] Other: _______
Description of Incident
Describe exactly what happened. Include who was present, what the child was doing, what you observed, and the sequence of events. Be factual — describe what you saw, not what you think happened.
Injury Description (complete if applicable)
Body Part(s) Affected: [ ] Head/face [ ] Neck [ ] Shoulder [ ] Arm/elbow [ ] Wrist/hand [ ] Finger(s) [ ] Chest/back [ ] Hip/pelvis [ ] Leg/knee [ ] Ankle/foot [ ] Toe(s) [ ] Multiple areas [ ] Not applicable
Left or Right side (circle): Left / Right / Both / N/A
Injury Appearance: [ ] Redness [ ] Swelling [ ] Bruising [ ] Cut/abrasion [ ] Bite mark [ ] Bump/lump [ ] No visible mark [ ] Other: _______
Child’s Complaints (what the child said, if verbal):
Immediate Action Taken
Describe exactly what you did in response.
First Aid Provided: [ ] Cleaned wound [ ] Applied bandage [ ] Ice pack applied [ ] Comfort/monitoring [ ] None needed [ ] Other: _______
Was 911 called? [ ] Yes [ ] No
Was the child transported for medical evaluation? [ ] Yes [ ] No If yes, transported by: [ ] 911/ambulance [ ] Parent [ ] Director [ ] Other: _______ Transported to: _______________________________________________
Staff Present
Staff Member 1 (completing this report): _______________________________________________
Staff Member 2 (also present): _______________________________________________
Staff Member 3 (also present): _______________________________________________
Total number of children in the area at time of incident: _______
Were ratios maintained at time of incident? [ ] Yes [ ] No If no, explain: ______________________________________________________________________________
Parent/Guardian Notification
Time parent was first contacted: ___________ [ ] AM [ ] PM
Method of contact: [ ] Phone call [ ] In-person at pickup [ ] Written note [ ] Other: _______
Name of parent/guardian reached: _______________________________________________
Parent’s response/reaction: _______________________________________________
Parent signature confirming notification (if signed at pickup): _______________________ Date: ___________
If parent could not be reached:
Attempts to contact:
| Attempt # | Time | Method | Result |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 |
Emergency contact contacted (if parent unreachable)? [ ] Yes [ ] No Name reached: _______________________________________________ Time: ___________
Follow-Up Required
[ ] None — incident fully resolved [ ] Child monitored during day for symptoms — describe: _______________________________________________ [ ] Licensing agency notification required (see reporting thresholds) [ ] Family requested follow-up call — scheduled for: _______________________________________________ [ ] Physical environment change needed — describe: _______________________________________________ [ ] Staff training or procedure review needed — describe: _______________________________________________ [ ] Other follow-up: _______________________________________________
Signatures
Reporting Staff Member:
Signature: ___________________________ Printed Name: ___________________________ Date: ___________
Director Review:
Signature: ___________________________ Printed Name: ___________________________ Date: ___________
Does this incident require licensing agency notification? [ ] Yes [ ] No
If yes — Date/time reported to licensing agency: ___________ Method: _______ Person contacted: _______
Weekly Incident Log
Director completes this at the end of each week by reviewing all individual incident reports for the week. Use this log to identify patterns.
Week of: ___________________ to ___________________
| Date | Child (initials) | Age/Room | Incident Type | Body Part / Area | Parent Notified (Y/N) | Licensing Report Required (Y/N) | Follow-Up Complete (Y/N) |
|---|---|---|---|---|---|---|---|
Week’s Total Incidents: _______
Patterns Observed This Week:
Action Items for Next Week:
Director Signature: _________________________ Date: ___________
Definitions: Reportable vs. Minor Incidents
Minor Incidents (Internal Report Only)
These events require an internal incident report but typically do not require notification to the licensing agency:
- Small cuts and scrapes treated with basic first aid
- Minor bumps and bruises with no medical attention required
- A child who momentarily fell or tripped without significant injury
- Minor biting incidents where skin was not broken or injury was minor
- A child who cried for an extended period due to separation anxiety
Even minor incidents must be documented in writing and disclosed to the parent.
Reportable Incidents (May Require Licensing Notification)
The following incident types commonly require notification to the licensing agency. Check your specific state’s requirements — thresholds vary.
- Any incident requiring 911 or emergency medical services
- Any incident resulting in a child being transported to urgent care, an emergency room, or a hospital
- A child who left the facility without authorization (elopement)
- A medication error (wrong child, wrong dose, wrong medication, wrong time)
- A child fatality
- Suspected abuse or neglect of any child in your care
- A serious injury requiring stitches, casting, or medical evaluation
- A communicable disease outbreak (multiple cases of the same reportable illness)
- Any incident in which a ratio was substantially violated and a child was injured
Most states require notification within 24 hours for serious incidents. Some require notification within hours. Know your state’s requirement before an incident happens.
When to Call 911 Immediately
Do not delay calling 911 for any of the following:
- A child is unconscious, unresponsive, or not breathing normally
- A child has a seizure (first-time or prolonged)
- A child has a severe allergic reaction (hives, swelling, difficulty breathing)
- There is bleeding that cannot be controlled
- A suspected broken bone, especially involving the head, neck, or spine
- A child has ingested a toxic substance (call Poison Control at 1-800-222-1222 and follow their instructions)
- Any situation where you believe a child’s life may be at risk
When in doubt, call 911. You can always cancel if it turns out to be less serious than it appeared.
Record Retention by Incident Type
| Incident Type | Minimum Retention |
|---|---|
| Minor incident reports | 5 years |
| Injury requiring medical attention | Until child turns 21 |
| Incidents requiring state licensing report | Permanently |
| Medication error reports | 5 years |
| Elopement incidents | Permanently |
| Fatality | Permanently |
| Weekly incident logs | 5 years |
Store incident reports in a secure, locked location separate from general child files. In the event of a legal claim or licensing investigation, these records may be subpoenaed.