Unit Two Creating a Safe and Healthful Environment 222 Copyright Goodheart-Willcox Co., Inc. Forms Every center should develop a number of forms related to the health and safety of the children. Many of these forms direct the staff in the care of the children and protect staff members from possible liability. Two forms commonly used by centers are incident report forms and various types of release or permission forms. Every center should have a standard incident report form. No matter how minor, any injury to a child needs a written report. Any information recorded on this form is useful if legal action is brought against the center. Parents also need to be informed about the details of a child’s accident. The parental signature on the form conveys that they received the report. A sample form is shown in Figure 11.13. Figure 11.13 Incident Report Form Child and Family Study Center Child’s Name: ______________________________________________________________ Date of injury: _____________________ Time of injury: _____________________ a.m./p.m. Type of injury: bite, broken bone, bruise, burn, choking, cut, ear, eye, head, poisoning, scrape, sliver, sprain, other _____________________________________________________________________ Staff members present: ______________________________________________________ Witness(es): _______________________________________________________________ Description of the incident: (Include specific information, such as where the child was playing, with whom, and with what.) Description of injury: (Include specific information, such as type, location, size, and severity of injury and symptoms noted following injury.) Action taken by staff: (Include all actions, such as treating injury, seeking medical advice or care, comforting child, and notifying director and parents.) __________________________________________________________________________ (staff signature) __________________________________________________________________________ (parent signature)