Back to resources
Template September 21, 2026Learning Clubhouse
Incident Report Template
A printable incident report form — child, time, what happened, action taken, and parent notification.
Incident Report
Date: ____________ Time: ____________
Child: ____________ Classroom: ____________
Staff present: ____________ Location: ____________
Type of incident
☐ Injury ☐ Illness ☐ Behavior ☐ Other: ____________
What happened
______________________________________
Action taken
______________________________________
First aid / follow-up
______________________________________
Parent notified
☐ In person ☐ Phone ☐ App message ☐ No
Time: ____________ By: ____________
Staff signature
____________________ Date: ____________
Made with Learning Clubhouse.