Kid City Student Incident Form

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An internal form used to document student incidents.

* Indicates required question

Employee completing this incident form: *

Your answer

Student Name *

Your answer

Others Involved (write N/A if no one else was involved) *

Your answer

Date *

MM

/

DD

/

YYYY

Time *

Time

:

AM

PM

Location *

Gym

Playground/Outside

Lobby

PreK Room

Other:

Description of Incident *

Your answer

Was someone injured? If so, who? *

Your answer

Was a Parent/Guardian contacted? *

Yes

No

Parent Name and Method of Contact (ie. phone or Brightwheel)

Your answer

Was Amin Notified? *

Yes

No

Maybe

Questions/comments/concerns:

Your answer

Submit

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