Playground Incident Follow-Up Report
Incident Details
Date of Incident
Time of Incident
Location
Description of Incident
People Involved
Name(s) of Individual(s) Involved
Witnesses (if any)
Supervisor/Staff Present
Injury & Response
Nature of Injury (if any)
First Aid Provided?
Yes
No
Action Taken
Parent/Guardian Notification
Notified?
Yes
No
Notification Method
Date & Time of Notification
Follow-Up & Recommendations
Required Follow-Up Actions
Recommendations/Comments
Report Completed By
Date
Signature