Serious First Aid Report

Full name of injured person

D.O.B of injured person

Nature of injury/illness

Fracture
Dislocation
Strain / Sprain
Laceration / Cut
Burn
Bruising
Dental Injury
Bite / Sting
Shock
Concussion
Eye Injury
Head Injury
Graze
Blood Nose
General Sickness
Soiled
Other (state in description section)

Body part injured

Head
Throat
Teeth
Ear
Nose
Eye
Neck
Back
Shoulder
Chest
Abdomen
Arm
Hand
Pelvis
Genitals
Buttocks
Leg
Foot
Ankle
Other (state in description section)

Description - cause of injury

Type of first aid given

Band-Aid
Sling
Bandage
Ice Pack
Antiseptic
Eye Wash
Returned to play
Alternate Duties
Parents advised to seek medical advice
Sent to hospital

Date

Time

First aid given by

Were parents notified

Yes
No

What was staff:child ratio

Who was the supervising staff member/s

Any contributing factors

e.g. type of activity happening type of equipment out