Accident Referral Letter

This report is for reporting and recording accidents and incidents.

On the left navigation panel, select Student Master, Entry and Student Master, and Actions is located in the top right corner of the screen.

Set Up Options

• Date - this is the date the accident/incident happened
• School Site - this is the school where the accident/incident happened
• Date of Birth - this the birth date of the student
• Grade - this is the grade level of the student
• Address - this is the address of the student
• Phone - this is the contact number of the student

• Accident/Incident Location

• Classroom
• Playground
• Gym
• Bus
• Other

• Was Parent Notified

• Yes
• How
• Witness

• Was the Claim Form Provided

• Yes
• No

• Cause of Injury

• Machine, Tool, Thing or Person, give details

• Part of Body Injured

• Describe the Incident Included Supervision
• Describe the First Aid Measure(s)

• Return to Class
• Called Parent
• Parent will Pick Up
• Hospital Emergency
• Call 911
• School Nurse Visit
• Other

• Person Completing Report

• Name
• Title
• Date

• Principal

• Date

• Supervisor

• Date

Optional tabs across the bottom: Save, New, Print, Delete, Close, First, Previous, Next and Last

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