Field Trip Injury/Accident Report Form
Field Trip Details
Field Trip Name/Location
Date of Trip
Teacher/Chaperone Name
Injured Person Information
Full Name
Grade/Group
Parent/Guardian Contact
Injury/Accident Details
Date of Incident
Time
Location of Incident
Describe the Accident/Injury
Cause (if known)
Immediate Action Taken
Describe First Aid/Action Provided
By Whom
Further Action Taken/Referred to (Clinic, Hospital, etc.)
Witness Information
Witness Names & Contact Info
Report Completed By
Name
Date