Accident Report

Accident Report

* Indicates required field

Student Name *

First

Last

Grade *

Description of accident *

Place where accident occurred *

Witnesses *

Date of accident *

Time of accident *

Were parents notified? *

Yes No

What type of treatment was administered? *

Was student sent home? *

Yes No

Who was supervising activity? *

First

Last

Name of person filing accident report *

First

Last

Comments *

Submit