Print Incident Report: When you have finished filling out the event form, you can print an incident report in DPW format to be signed by the parent.
Date: Date of the event. This defaults to today’s date so be sure to update it if you are entering an event a few days later.
Time: Time of the accident. This can help you identify patterns in the time of day that accidents are more likely to occur.
Location: Location of the accident. This can help you identify patterns in the locations where accidents are more likely to occur.
Staff Present: Staff that were present when the accident took place. This can help you identify patterns in staffing that might affect when accidents are more likely to occur.
Other Children Involved: Record any other children involved in the incident, if any.
Type of Injury: Select from a list of common injuries or select “Other” and enter specifics.
Body Part Injured: Select from a list of common injuries or select “Other” and enter specifics.
Cause: Enter the cause of the injury if known.
Equipment Involved: Select from a list of typical equipment or select “Other” and enter specifics. This can help you identify patterns in the types of equipment usually involved in accidents.
First Aid: If the child was given any first aid, enter it here and indicate by whom it was administered.
Parent/Guardian: You can indicate which, if any of the child’s parents or guardians were contacted by whom and at what time. You can also indicate whether or not a parent/ guardian came to pick up the child and at what time that occurred.
Local Authority: If the event was serious enough to warrant a call to 911, you can record who called the emergency services and at what time. You can also record what specific service came to your assistance.
Emergency Room: If the child was taken to the emergency room, you can indicate by whom and at what time. You can also record the name and contact information of the ER and specify what treatment the child received. If there is a need for specific medical follow up, you can enter it here and add a reminder so you remember to follow up.
Regional Day Care Office: For serious incidents resulting in ER treatment, hospitalization, death, or the dispatch of emergency services, the regional day care office (in Pennsylvania, this is your local DPW office) must be notified. You can indicate who notified the office and when; you can also record the name of the specific person at the office to whom the report was filed.
Other Action Taken: If any other steps were taken in response to the incident, you can enter them here.