Gordonvale Incident Injury Report
Tick relevant type of injury
Abrasion or ScrapeBiteBroken Bone or FractureBruiseBurnConcussionCutRashSprainSwellingOther
Please note details of action taken including first aid administration of medication and child temperature recording. NB: Record LOCATION and TIME each action is taken
Injury Position on body
FingersHandWristForearmElbowUpper ArmShoulderNeckFace-CheekFace-MouthFace-NoseFace-EyesFace-ForeheadFace-EarsHeadUpper BackLower BackButtocksUpper LegKneeCalfAnkleFootToes
Medical Person contacted?
Parent or Guardian Notified?
PhoneSMSEmail
I, Name of Parent/Guardian have been notified of my child's illness.
Incident reported to:
Follow up conversations with staff:
Follow up conversation with parents/guardians
If yes, is record of conversation noted on child's file?
Report Filed
Save Draft