Incident, injury, trauma & illness record

Complete as soon as possible after the event. Write facts only — what you saw and did, not opinions. A parent or guardian must sign on collection.

Child and event details

Child's name

Date of birth

Date of incident

Time of incident

Location (room / yard / excursion)

Educator completing this form

Type of event (tick all that apply)

Injury

Illness

Trauma / distress

Near miss

Missing or unaccounted child

Other (describe below)

What happened

Describe exactly what occurred, in the order it happened. Include what the child was doing and who was present.

Injury or illness details

Part of body affected

Symptoms observed

First aid / action taken

Include who administered first aid, what was given, and the time.

Notifications

Parent / guardian contactedTime: ________ By: ________

Nominated supervisor informedTime: ________

Ambulance / medical assistance calledTime: ________

Regulatory authority notification required (serious incident)

Follow-up and prevention

What will change to reduce the chance of this happening again? Link to your risk assessment if one needs updating.

Signatures

Educator — signature & date

Parent / guardian — signature & date

Serious incidents must be notified to the regulatory authority within 24 hours under the National Law. Keep this record until the child turns 25. Supports NQS Quality Area 2 and Element 2.2.3.