JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
KIND Accident Report Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Staff Name
*
Your answer
Child's Name
*
Your answer
Details of Accident: What happened? Give cause, how, and why:
*
Your answer
Nature of Injury:
*
Your answer
Other person(s) involved in accident:
*
Your answer
When it happened: Date and Time and Location:
*
Your answer
What action was taken? Treatment?
*
Your answer
Parent/guardian notified?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Kids In New Directions.
Report Abuse
Forms
