Child Accident Form Template UK

The Child Accident Form Template UK is provided in multiple formats, including PDF, Word, and Google Docs, featuring samples that are both editable and printable.

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Sample

Child Accident Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Child Accident Form Template UK

1. Child Information



2. Parent/Guardian Information


3. Accident Details


4. Description of Accident

5. Nature of Injuries

6. Witness Information


7. Response and First Aid Provided

8. Follow-Up Actions Required

9. Consent and Acknowledgment


PDF

WORD

Examples

Child Accident Form Template UK (1)
Child Details:
[Child’s Full Name]
[Date of Birth]
[Address]
[Emergency Contact Name]
[Emergency Contact Phone Number]
Accident Details:
Date of Incident: [Date]
Time of Incident: [Time]
Location of Incident: [Location] (e.g., School Playground)
Description of the Incident: [Detailed description of what happened, including the child’s activities prior to the accident].
Injuries Sustained:
[List of injuries, e.g., cuts, bruises, fractures, etc.]
Severity of Injuries: [Mild/Moderate/Severe]
Action Taken:
First Aid Administered: [Yes/No]. If yes, please describe: [Description of first aid actions taken].
Was medical assistance required? [Yes/No]. If yes, please specify: [Details of medical assistance sought, including hospital/clinic visited].
Witnesses:
[List any witnesses to the incident, including names and contact information if applicable].
Reporting Details:
Reported By: [Name of the person reporting the incident]
Relationship to the Child: [e.g., Parent/Guardian/Teacher]
Date of Report: [Date]
Signature: [Signature of the person reporting]
Child Accident Form Template UK (2)
Child Information:
[Child’s Full Name]
[Date of Birth]
[Address]
[Parental Contact Name]
[Parental Contact Phone Number]
Accident Information:
Date of Accident: [Date]
Time of Accident: [Time]
Setting of Accident: [Location, e.g., Childcare Center or Home]
Account of the Event: [Thorough description outlining circumstances leading to the accident].
Injuries:
[Detailed description of injuries, e.g., abrasions, head injury, etc.]
Injury Severity Level: [Light/Moderate/Serious]
Response to the Incident:
Was first aid given? [Yes/No]. If yes, outline the steps taken: [Summary of first aid procedure followed].
Medical Attention Required? [Yes/No]. If yes, include details: [Medical facility and treatments received].
Witness Information:
[Names and contact details of witnesses present during the accident].
Reported Information:
Completed By: [Name of individual completing the form]
Role: [Parent/Guardian/Staff Member]
Date Form Completed: [Date]
Signature: [Signature of the individual completing the form]

Printable

PDF – 1 PDF – 2

Child Accident Form Template UK