Critical Incident Report

Your name

Date

Nature of critical incident

Any incident involving serious injury or trauma to, or illness of, a child while being educated and cared for by an education and care service, which: (i) a reasonable person would consider required urgent medical attention from a registered medical practitioner or (ii) for which the child attended, or ought reasonably to have attended, a hospital. e.g whooping cough, broken limb, anaphylaxis reaction
any incident where the attendance of emergency services at the education and care service premises was sought, or ought reasonably to have been sought
any circumstance where a child being educated and cared for by an education and care service (i) appears to be missing or cannot be accounted for or (ii) appears to have been taken or removed from the education and care service premises in a manner that contravenes these regulations or (iii) is mistakenly locked in or locked out of the education and care service premises or any part of the premises
The death of a child: (i) while being educated and cared for by an education and care service or (ii) following an incident while being educated and cared for by an education and care service

Parties you have notified so far

Parents
School
Emergency services

Time of incident

Name of people affected

Where did the incident occur

Child:staff ratio in the area at time of incident

Child:staff ratio across the service at the time

Description of incident

Recommendations for further action