BCS Injury Report
Date
*
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Your Email
*
Reporting Adult's Name
*
Student Name
*
Witnesses
*
Parents Called
*
YES
NO
School Insurance?
*
YES
NO
Describe Injury
*
School Nurse Notified
*
YES
NO
Action Taken
*
Submit
Should be Empty: