Injury ReportChild's Name: Date of Injury: __ /__ /__ When did the injury happen? ________________________________________________ Location where injury occurred ______________________________________________ Equipment or product (For example, chair / glue) involved ____________________________ Description of injury or which parts of the body were injured? _________________________ How did the injury happen? ________________________________________________ Who gave first aid and what they did: _________________________________________ Where else did the child receive treatment and what was done: Follow-up plan for care of the child __________________________________________ |