Daycare Incident Report Form & Template (Printable PDF, Sample & Ouch Report)
Free PDF and Word · Updated
A daycare or child care incident report documents a child's injury or medical event: what happened, the care given, who saw it, and staff and parent signatures. State licensing rules decide what goes beyond that internal record; in New York, for example, a serious injury or a hospital transport must be reported to the parent and to OCFS immediately.
Incidents involving children demand rigor and transparency with families. This template includes a dedicated field for the person involved, witnesses, and a dual staff/supervisor signature.
What this template includes
Every field below is part of the free template and the mobile version; nothing is locked behind a paywall for filling out a single report.
- Report number and date/time of the incident
- Location or site
- Reporter's name and role
- Severity (minor, moderate, or critical)
- Person(s) involved: name, role, contact
- Witness(es): name, phone
- Description of events
- Immediate action taken and root cause (if known)
- Up to 3 timestamped photographs
- Reporter signature
- Witness or supervisor signature
Sample completed report
What this template looks like filled in. Every name, place and time below is invented.
- Report number
- CC-2026-0088
- Date and time of incident
- Wednesday, May 13, 2026, 3:15 p.m.
- Location
- Outdoor playground, slide area
- Reported by
- K. Morgan, lead teacher, preschool room
- Severity
- Minor
- Child
- L.B., age 4
- Witness
- R. Singh, assistant teacher
- Injury and care given
- Small scrape on the right knee; cleaned with water, bandage, ice pack for 5 minutes
- Parent notified
- In person at pickup, 5:40 p.m.; copy of the report given
- Signatures
- Teacher, director and parent
Description of events
At 3:15 p.m., L.B. was running toward the slide, tripped on the edge of the rubber mat and fell onto the right knee. I was about ten feet away and saw the fall. L.B. cried briefly and was calm within two minutes. I cleaned the scrape with water, applied a bandage and gave an ice pack for five minutes. There was no swelling or limping afterward, and L.B. went back to play. The edge of the mat was lifted about an inch; I told the director, and the mat was secured before the next outdoor period. I told the parent at pickup and gave them a copy of this report.
More filled-in reports, one per kind of incident: 10 incident report examples.
How to file a defensible daycare & schools report
- 1
Document while the details are clear
Record what happened, where, and what care was given, before the end of the shift, not from memory the next day.
- 2
Note who witnessed it
Record which staff member was present and any other children or adults who saw what happened.
- 3
Get staff and supervisor sign-off
Have the reporting staff member and a supervisor sign the report before it goes home.
- 4
Share it with the parent the same day
Most licensing bodies expect written notice to reach the parent or guardian the same day: a mobile-filed report with instant PDF makes that realistic.
Common use cases
- Minor fall or injury during recess
- Medical incident (allergy, illness)
- Conflict between children
- Incident during a field trip
Frequently asked questions
Do parents need to sign the report?
Policies vary by state and facility, but many licensing bodies expect a staff member or supervisor to sign the report and a copy to be shared with the child's parent or guardian, typically the same day.
How long should a daycare keep incident reports?
Most state licensing agencies require child-care incident records to be kept for several years, and some require the file to be retained until the child reaches a certain age. Check your state's specific childcare licensing requirements.
Does this template work for New York's OCFS incident reporting?
New York's Office of Children and Family Services publishes its own form for licensed child care programs, the OCFS-4436 (Incident Report for Child Day Care), and requires the parent and OCFS to be notified immediately of serious incidents, serious injuries and hospital transports. This template captures the same core facts (what happened, the care given, staff and parent sign-off) for your internal record; use the OCFS-4436 from ocfs.ny.gov when OCFS needs the report. Form 7239 is the Texas equivalent, not a New York form.
What is an "ouch report"?
An "ouch report" is the everyday term child care staff use for documenting a minor bump, scrape, or bruise: the kind of small incident often just handed to a parent at pickup rather than requiring the same formal write-up as a more serious injury. Some states treat it as informal parent communication; others expect it logged the same way as any other incident. This template works for both: a quick entry for a minor bump, or a fuller report when supervisor sign-off is required.
Is there a printable daycare incident report?
Yes. The free PDF on this page prints with the fields a child incident report needs: the date, time and place, what happened, the people involved and witnesses, the immediate action, up to three photos, and the reporter and supervisor signatures. Your state licensing rules may ask for more, such as the parent's signature, so check them.
For the federal recordkeeping rules referenced above, see OSHA's recordkeeping requirements.
Related reading
Are Daycares Exempt From OSHA Recordkeeping?
Child day care services (NAICS 6244) are OSHA-exempt for staff injuries, which is unrelated to state incident-report rules for an injured child.
Compliance guideOCFS Incident Report (OCFS-4436): What New York Child Care Programs Must Report
Where to download the OCFS-4436 incident report PDF, what New York child care programs must report to OCFS and parents immediately, and why 7239 is Texas's.
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