I had to sign an accident report for Luke when I picked him up from daycare the other day.

Name of Child:   Luke

Date of incident/ illness: 21.6.10

Time of incident / illness: 5:20 pm

What Happened:  Hugged by another child - fell backwards and hit head on the floor

Injuries / symptoms:  bump on head (at the back)

First Aid applied:  ice pack and cuddles

Parent contacted: n

Teacher in area Signature 

Person responsible signature

Parent / Guardian signature