Medical & First Aid Incident Report
This form must be completed by the staff member who provided first aid on the same day of the date of the incident. For students, enter the Unique ID using lastname.firstname or lastname.nickname and then CLICK the Unique ID button.
Date of Incident
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Month
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Day
Year
Date
Time of Incident
*
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Minutes
AM
PM
AM/PM Option
Unique ID
Student Name
Name of Person Completing Report (First Aid Provider)
*
First Name
Last Name
Name of Person Receiving First Aid, if not a student
Cause of incident (if known)
What happened?
*
Name and contact of any additional person(s) witnessing incident
Condition of the student or staff
*
Upload any relevant photos or documentation
Browse Files
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Time first aid provided
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12
:
Hour
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Minutes
AM
PM
AM/PM Option
Actions Taken and Who did you Notify? (Administration, Parents, 911, School Nurse)
*
Medical follow-up sought (if applicable)
Any additional information
Signature
*
Date of Report
*
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Month
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Day
Year
Date
Parent / Guardian Signature
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Submit
Should be Empty: