A scraped knee at 10:40 needs a written report before pickup at 5:30. Fill this in while it is fresh, then print one page for the teacher, the director and the parent to sign. No account, and nothing you type leaves the page.
Pre-filled with a typical playground fall so you can see the level of detail. Edit any field, or start blank. Everything stays in this browser tab; nothing is saved or sent.
1When and where
Room or area, as specific as you can.
2Who was supervising
Ratio at the time
1:4
3What happened
What the child was doing, what happened, what you saw. Facts in order, no guesses about fault.
4Care given
What was done and when you checked again.
5Who was told, and when
6Witnesses and follow-up
The printed page
This is exactly what prints. Sign it by hand, give the parent a copy, file the original.
Incident / injury report
Little Oaks Child Care Center
Child
Maya R.
Date of birth
2023-03-14
Date and time of incident
2026-10-14 10:42
Location
Outdoor play yard, toddler side
Equipment or object involved
Low climber, bottom step (about 12 in. high)
Ratio at the time
2 staff, 8 children (1:4)
Staff present
J. Alvarez (lead), K. Brooks (assistant)
What happened (facts only, in order)
Maya was climbing down the steps of the low climber. She missed the bottom step and fell forward onto the rubber surface, landing on her hands and knees. She cried right away and was calm within about two minutes. Ms. Alvarez saw the fall from about six feet away.
Type of injury
Scrape, Bruise or bump
Body area
Left leg, Right leg, Right hand
Medical care
First aid on site only
First aid given by J. Alvarez (pediatric first aid current)
Gloves on. Washed both knees with soap and water and covered them with adhesive bandages. Cold pack on the right palm for 10 minutes. No swelling seen at 11:15.
Who was notified
Parent / guardian
Dana R. (mother)
10:55
Phone call
Director
T. Okafor
10:50
In person
Licensor: Not reportable under our licensing rules
Witnesses
J. Alvarez (lead teacher), K. Brooks (assistant teacher)
Follow-up for the child
Check knees for redness after nap. Copy of this report goes home at pickup.
Change made to prevent a repeat
Edge of the mat under the bottom step was lifted about 1 in. Taped the same day; replacement mat ordered.
Report completed by
J. Alvarez
StaffDate ________
DirectorDate ________
Parent / guardianDate ________
Copies: the child's file, the parent, the injury log
Incident, accident or serious incident
Staff use the words loosely, but the paperwork splits on one question: did a child get hurt, and how badly? The national health and safety standards, Caring for Our Children (CFOC), say programs should document any injury or incident to a child that needs first aid or medical care, tell the parent as soon as possible, and have the parent sign the report. That covers the bitten finger as much as the trip to urgent care.
What happened
Example
Paper trail
Who hears about it
Minor injury
Scrape, bump, a bite that did not break the skin
Injury report, signed by the parent
Parent the same day; director
Incident, no injury
Allergen exposure, a medication mix-up, a child out of sight
Incident report, plus your own review
Parent and director; check whether your licensor wants it
Serious injury
Anything needing a doctor, dentist, urgent care or 911
Injury report plus the licensor's own form if your state has one
Parent right away; licensor by your state's deadline
Death or suspected abuse
Any death in care; any sign of abuse or neglect
Whatever your licensor and state law require
911 or law enforcement and child protective services as your state's law says; licensor
Serious injuries have a federal hook. Under the federal Child Care and Development Fund rule, each state's lead agency has to require child care providers to report serious injuries and deaths of children in care to a designated state entity (45 CFR 98.42(b)(4)), name that entity in its CCDF plan (98.16(gg)), and post yearly counts of deaths and serious injuries on its consumer website (98.33). What counts as serious, the deadline and the form are set by each state, which is why you will not find one national answer.
CFOC Standard 9.4.1.10 adds that you should write down the moment you notify a parent about a serious event, on the incident or injury form itself, and keep it on file. The "Who was told, and when" rows above exist for exactly that.
One state's clock, read in full
To show how specific a state rule gets, here is Washington's. Your state's list and deadlines will be different, so treat this as a picture of the shape, not your rule.
Licensing requirement
Washington, WAC 110-300-0475 (as amended, effective May 15, 2026)
Call 911 immediately for a medical emergency that needs immediate professional care, then tell the department within 24 hours. Tell the parent immediately about a serious injury or any need for emergency or poison services. Submit a written incident report on the department's form within 24 hours for a serious injury to a child in care or anything that needed an emergency response.
Find your own state's version before you need it and write the deadline on the inside of your first aid kit lid. Our guide to daycare licensing requirements explains where those rules live, and the licensing checklist has a line for keeping the reporting procedure in your file.
How to write the narrative
The narrative is the part a parent, a licensor or an insurer will read twice. Write what the child was doing, what happened, and what you saw, in that order. CFOC's own example is the right length: "tripped while running on the playground and fell, scraping both knees." No guesses about fault, no diagnosis, no adjectives that judge a child.
Instead of
Write
Maya was being rough and fell.
Maya was climbing down the steps of the low climber and missed the bottom step.
Small scrape, she's fine.
Scrapes on both knees. No bleeding after washing. Calm within two minutes.
Teacher was watching.
Ms. Alvarez saw the fall from about six feet away.
Possible broken wrist.
Holding her right wrist and would not use the hand. Parent advised to see a doctor.
The person who saw it writes it, the same day, before their shift ends. Record the staff and child count at that moment too. A parent who asks "who was watching?" deserves a real answer, and a licensor will compare it with your posted ratio. If you are unsure what the right number was for that room, run it through the staff-to-child ratio calculator.
Bites and the other child
When one child bites or hurts another, the injured child's report describes the injury and what staff did. Most programs keep the other child's name off the copy that goes home and write a separate report for that child's family.
After the signatures
The CFOC sample incident form ends with a routing line: one copy for the child's folder, one for the parent, one for the injury log. CFOC 9.4.1.9 also asks programs to keep injury forms organized as minor and serious so they are easy to review, and to look for patterns that need a fix. Ten scraped knees under the same climber in a month is a surfacing problem, not ten accidents.
Allergies get their own rule. CFOC 4.2.0.10 says to complete an incident report after every food allergy incident or emergency, even when the child seems fine. That only works if the allergy is already on file, which is the job of the enrollment form, and it should line up with your sick policy on when a child goes home.
A note on the daily sheet is not a substitute. Anything that needed first aid gets its own report. Say so in your parent handbook, so families expect the form and the phone call. And for the events bigger than one child, a fire or a missing child, the steps belong in your emergency plan.
How long to keep them
There is no single national retention period. Your licensor sets a minimum and your liability insurer may want longer, because injury claims can arrive well after a child leaves. Ask both, write the answer into your records policy, and do not shred until you have it.