1.Use this form to record/verify any physical evidence of injury from an incident, OR in the event that a
routine encounter reveals an injury.
2. Staff are not to conduct checks involving removal of clothing from “bathing suite” areas of the child’s body;
notify the site supervisor if suspension of severe injury exists.
3.Mark and Label on the body figure below all bruises, cuts, burns, etc. on the body area in question.
4.Make any notations of findings/lack of findings under the comment section.
5.All findings must be reported to the site supervisor.