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It captures the injured body part, accident type, location, and contributing causes across environmental, human, and agent factors. It also records first aid and notifications, tetanus advice, medical destinations, absence days, and follow-up actions, including staff, policy, and corrective measures with witness and signature fields.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/school-accident-report-form-complete-injury-and-incident-details-checklist/252883/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/school-accident-report-form-complete-injury-and-incident-details-checklist/252883.png","ImageObject",442,249,{"name":88,"@type":89},"Hazel","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-15","2026-09-13",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information does the form collect for accident identification?","Question",{"text":108,"@type":109},"It gathers whether the person is a student or employee, name, grade or position, age, and sex, plus the accident time and date.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does the form document injury and accident specifics?",{"text":113,"@type":109},"It records whether the activity was supervised, the nature of injury categories, the part of body injured, the kind of accident, and where the accident happened.",{"name":115,"@type":106,"acceptedAnswer":116},"What post-accident steps must be recorded?",{"text":117,"@type":109},"The form checks whether first aid was given, whether parents/responsible persons were notified, whether tetanus immunization was advised, where the injured person was sent, and the days absent from school or work.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},252883,1789263300,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":9,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":9},137441390410,"https://ap-avatar.wpscdn.com/avatar/2000252f4ab5702993?_k=1776741390130283984","School Accident Report Form  \nGENERAL INFORMATION  \nSchool   Student o Employee o  \nA. Name  Last First Middle Initial  \nB. Grade   Position   C. Age   D. Sex-Male o-Female o  \n*********************************************************************************************************************** ACCIDENT INFORMATION  \nA. Time of Accident   a. m   p. m. Date   B. Supervised Activity? o Yes o No  \nC. If yes, person in charge   \nD. Nature of Injury (may be completed after medical examination)  \n1. o Abrasion 4. o Burn 7. o Fracture 10. o Sprain  \n2. o Bruise 5. o Concussion 8. o Laceration/Cut 11. o Strain  \n3. o Bump 6. o Dislocation 9. o Puncture 12. o Other  \nE. Part of Body Injured  \nI. Head II. Trunk III. Arms IV. Legs  \n1. o Scalp 1. o Chest 1. o Shoulder 1. o Hip  \n2. o Back 2. o Abdomen 2. o Upper Arm 2. o Upper Leg  \n3. o Front 3. o Back 3. o Elbow 3. o Knee  \n4. o Eyes 4. o Lower Arm 4. o Lower leg  \n5. o Ear 5. o Hand 5. o Foot  \n6. o Nose 6. o Fingers 6. o Toes  \n7. o Mouth  \n8. o Tooth  \n9. o Neck  \nF. Kind of Accident (1) G. Where Accident Happened (1)  \n1. o Animal bite or insect bite 1. o Athletic Field  \n2. o Collision with student (bump, etc. ) 2. o Cafeteria  \n3. o Contact with hot or toxic substance 3. o Classroom  \n4. o Fall or slip 4. o Gym  \n5. o Fighting 5. o Hallway  \n6. o Struck by auto, bike, etc. 6. o Playground  \n7. o Struck by object (swing, etc. ) 7. o Restroom  \n8. o Student collided with object 8. o School Bus  \n9. o Other   9. o Stairway  \n10. o To or from school  \n11. o Vocational/Shops/Labs  \n12. o Other    \nCONTRIBUTING CAUSES  \nA. Environmental Factors (1) B. Human Factors (1) C. Agents (1)  \n1. o Crowding 1. o Active game 1.o Animal or insect  \n2. o Doors 2. o Fatigue 2.o Electricity  \n3. o Drinking fountain 3. o Fighting 3.o Fire  \n4. o Equipment 4. o Horseplay 4.o Gases  \n5. o Floors 5. o Lack of training/experience 5.o Liquids  \n6. o Hard surface 6. o Preoccupation 6.o Recreation equipment  \n7. o Lighting 7. o Running 7.o Pencil  \n8. o No handrail 8. o Violation of rules 8.o School equipment  \n9. o Weather 9. o Other   9.o Vehicle  \n10. o Other   10. o Other   \nACCIDENT DESCRIPTION  \nDescribe the accident in your own words. Please give all details so that this accident report may be used to prevent other similar accidents.  \n****************************************************************************************************************** ******  \nPOST-ACCIDENT INFORMATION  \nA. Was first aid given? o Yes o No By Whom:  Description of first aid:    \nB. Was parent or other responsible person notified? o Yes o No By whom:   If no, explain    \nC. Advised on tetanus immunization? o Yes o No  \nD. o Injured, sent home. If so, was he/she accompanied? o Yes o No  \no Injured, sent to physician. Name of physician    \no Injured, sent to emergency room. Name of hospital    \nE. Days absent from school or work    \n******************************************************************************************************************************* ************  \nACTION TAKEN  \nA. Instructional  \n1. o Discussed at staff meeting 4. o Personal instruction given to injured  \n2. o Discussed in each class as part of regular instruction 5. o Personal instruction given to person in charge  \n3. o Discussed with parent 6. o Presented as a subject of assembly program  \nB. Policy or Corrective Action  \n1. o Environmental changes affected 2. o Notified school safety committee  \n3. o Safety rules amended to prevent recurrence 4. o Safety specialist visit to assist in safety program  \n5. o Suggest closer supervision 6. o Other    \n7. o No action taken  \nSigned:   Title:   Other Witnesses:","cbCaikv2djbuAmTn","https://ap.wps.com/l/cbCaikv2djbuAmTn","pdf",19337,"English","# General Information\n## Accident Information\n## Contributing Causes\n## Accident Description\n## Post-Accident Information\n## Action Taken","[{\"question\":\"What information does the form collect for accident identification?\",\"answer\":\"It gathers whether the person is a student or employee, name, grade or position, age, and sex, plus the accident time and date.\"},{\"question\":\"How does the form document injury and accident specifics?\",\"answer\":\"It records whether the activity was supervised, the nature of injury categories, the part of body injured, the kind of accident, and where the accident happened.\"},{\"question\":\"What post-accident steps must be recorded?\",\"answer\":\"The form checks whether first aid was given, whether parents/responsible persons were notified, whether tetanus immunization was advised, where the injured person was sent, and the days absent from school or work.\"}]","School Accident Report Form - Complete Injury and Incident Details Checklist | PDF"]