Incident, Injury, Trauma and Illness Record
About the Incident, Injury, Trauma and Illness Record
A comprehensive digital incident report form designed to meet the requirements of Regulation 87 of the Education and Care Services National Regulations. This template captures all mandatory details including child information, incident circumstances, time and date, actions taken, witness details, parent notification, and required signatures. The multi-step signing workflow ensures both the responsible person and parent/guardian review and sign the record.
Also called
- Incident report form
- Injury report form
- Accident report form
- Incident injury trauma and illness record
What's on this form
Every question included in the incident, injury, trauma and illness record. Add, remove or reword any of them in the form builder.
Step 1 — Completed first
Filled in by the educator or responsible person
Child Details
Child Details
Child details
Incident/injury/trauma/illness Details
Date
Date
Time
Time
Location
- Playground
- Arts and Crafts
- Playroom
- Kitchen
- Play Equipment
Choose one
First person on scene
Short answer
Did anyone witness this incident?
Yes / No
Witness Signature
Signature
Incident/injury/trauma/illness Description
Products / Structures Involvedoptional
Short answer
Circumstances leading to the Incident/injury/trauma/illness
Long answer
Description of Incident/injury/trauma/illness
Long answer
Nature of Incident/injury/trauma/illness
- Abrasion/ scrape
- Allergic Reaction (not anaphylaxis)
- Amputation
- Anaphylaxis
- Asthma/ respiratory
- Bite wound
- Broken Bone/ fracture/ dislocation
- Bruise
- Burn/ sunburn
- Choking
- Concussion
- Crush/ jam
- Cut/ open wound
- Drowning (non fatal)
- Electric shock
- Eye injury
- High temperature
- Infectious disease (e.g., gastrointestinal)
- Ingestion/ inhalation/ insertion
- Internal injury/ infection
- Pain
- Poisoning
- Rash
- Respiratory
- Seizure/ unconscious/ convulsion
- Sprain/ Swelling
- Stabbing/ piercing
- Tooth
- Venomous bite/ sting
Choose any
Was the child missing or unaccounted for?
Yes / No
Circumstances if child appeared to be missing or otherwise unaccounted for (include. duration, who found child, etc.)
Long answer
Was the child taken/removed from service or locked in/out?
Yes / No
Circumstances if child appeared to have been taken or removed from service or was locked in/out of service (include who took the child, duration)
Long answer
Was the child injured?
Yes / No
Parts of body injured
- Head
- Face
- Forehead
- Eye(s)
- Nose
- Mouth / Teeth / Lip
- Ear(s)
- Neck
- Shoulder(s)
- Arm(s)
- Elbow(s)
- Wrist(s)
- Hand(s)
- Finger(s)
- Chest
- Back
- Abdomen / Stomach
- Hip(s)
- Leg(s)
- Knee(s)
- Ankle(s)
- Foot / Feet
- Toe(s)
Choose any
Was this a head injury?
Yes / No
Concussion Test
Please notify the director immediately of any head injury! Check for the below signs and symptom of concussion:- Nausea, Problem balancing, Convulsions, Dizziness, Problem paying attention, Memory loss, double/blurry vision, Confusion, Sensitivity to noise and light. Ask the child each question below and record your answer.
Where are we now?
Long answer
Do you remember what happened?
Long answer
Comments
Long answer
Details of First Aid
Details of treatment including first aid administered
- Rest / Observe
- Ice Pack
- Band-Aid
- Disinfectant Wipe
- Cold Compress
- Warm Compress
- Wound Wash / Sterile Water
- Saline Solution
- Antiseptic Cream
- Gauze / Dressing Pad
- Medical Tape
- Compression Bandage
- Sling
- Splint
- CPR / Resuscitation
- EpiPen Administered
- Asthma Puffer Administered
- Called 000
Choose any
Description of First Aid Administered
Long answer
Person Who Administered First Aid
Educator signature
Parent / Guardian Notification Notes (If Applicable)optional
Long answer
Did emergency services attend?
Yes / No
Time emergency services was contacted
Time
Time emergency services arrived
Time
Provide details of emergency services attending:
Long answer
Was medical attention sought from a registered practitioner / hospital?
Yes / No
Provide details of medical attention sought:
Long answer
Person Completing This Record
Educator signature
Step 2 — Responsible Person
Completed by a staff member at the service
Have any steps been taken to prevent or minimise this type of incident in the future? If yes, provide details.
Long answer
Notifications (including attempted notifications)
Parent/guardian/carer
Yes / No
Name of Parent/guardian/carer
Short answer
Time Parent/guardian/carer was contacted
Time
Date Parent/guardian/carer was contacted
Date
Director
Yes / No
Name of Director
Short answer
Time Director was contacted
Time
Date Director was contacted
Date
Other agency (if applicable)
Yes / No
Name of Agency
Short answer
Time Agency was contacted
Time
Date Agency was contacted
Date
Regulatory authority (if applicable)
Yes / No
Name of Regulatory authority
Short answer
Time Regulatory Authority was contacted
Time
Date Regulatory Authority was contacted
Date
Responsible Person Details
Educator signature
Step 3 — Parent / Guardian
Sent to the parent or guardian to sign
Parent/Guardian Acknowledgement
I have been notified of my child's Incident/Injury/Trauma/Illness
Parent/Guardian Signature
Signature
How this form gets signed
This template runs as a multi-step signing workflow. Each person is notified in turn, and every signature is timestamped and stored against the record.
- 1
Responsible Person
Signs inside the service, using a staff PIN
- 2
Parent/Guardian
Signs externally — receives a secure link by email, no account needed
Australian regulations this form supports
The incident, injury, trauma and illness record is built around the Education and Care Services National Regulations. These are the regulations it helps you meet.
Incident, injury, trauma and illness policies and procedures
Services must have procedures for staff to follow when a child is injured, becomes ill, or suffers trauma.
Read the full text of Reg 85
The incident, injury, trauma and illness policies and procedures of an education and care service required under regulation 168 must include procedures to be followed by nominated supervisors and staff members of, and volunteers at, the service in the event that a child— (a) is injured; or (b) becomes ill; or (c) suffers a trauma.
Notification to parents of incident, injury, trauma and illness
Parents must be notified as soon as practicable, and no later than 24 hours after the occurrence — or alleged occurrence — of an incident, injury, trauma or illness.
Read the full text of Reg 86
The approved provider of an education and care service must ensure that a parent of a child being educated and cared for by the service is notified as soon as practicable, but not later than 24 hours after the occurrence, or alleged occurrence, if the child is involved in, or alleged to be involved in, any incident, injury, trauma or illness while the child is being educated and cared for by the education and care service.
Incident, injury, trauma and illness record
A record must include the child's name and age, circumstances, date/time, action taken, witnesses, notifications, and signatures.
Read the full text of Reg 87
(1) The approved provider of an education and care service must ensure that an incident, injury, trauma and illness record is kept in accordance with this regulation. (2) A family day care educator must keep an incident, injury, trauma and illness record in accordance with this regulation. (3) The incident, injury, trauma and illness record must include— (a) details of any incident in relation to a child or injury received by a child or trauma to which a child has been subjected while being educated and cared for by the education and care service or the family day care educator, including— (i) the name and age of the child; and (ii) the circumstances leading to the incident, injury or trauma; and (iii) the time and date the incident occurred, the injury was received or the child was subjected to the trauma; (b) details of any illness which becomes apparent while the child is being educated and cared for by the education and care service or the family day care educator including— (i) the name and age of the child; and (ii) the relevant circumstances surrounding the child becoming ill and any apparent symptoms; and (iii) the time and date of the apparent onset of the illness; (c) details of the action taken by the education and care service or family day care educator in relation to any incident, injury, trauma or illness which a child has suffered while being educated and cared for by the education and care service or family day care educator, including— (i) any medication administered or first aid provided; and (ii) any medical personnel contacted; (d) details of any person who witnessed the incident, injury or trauma; (e) the name of any person— (i) whom the education and care service notified or attempted to notify, of any incident, injury, trauma or illness which a child has suffered while being educated and cared for by the education and care service or family day care educator; and (ii) the time and date of the notifications or attempted notifications; (f) the name and signature of the person making an entry in the record, and the time and date that the entry was made. (4) The information referred to in subregulation (3) must be included in the incident, injury, trauma and illness record as soon as practicable, but not later than 24 hours after the incident, injury or trauma, or the onset of the illness.
Provided for information only and may not reflect the latest amendments. Refer to the Education and Care Services National Regulations (NSW) for the official legal text.
Where this form fits
The incident, injury, trauma and illness record is part of these jobs — each guide walks through the whole sequence and the other forms that go with it.
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What a school holiday program actually runs on — an authorisation for each excursion, transport consent, and the embarking and disembarking checks.
Daily records: what educators fill in as things happen
The records your staff complete during the day — incidents, illness, medication given, and observations of children’s learning.
Forms your educators fill in
The records staff complete — incidents and illness, medication given, observations, safety checks and transport.
Questions about the incident, injury, trauma and illness record
What is the incident, injury, trauma and illness record used for?
A comprehensive digital incident report form designed to meet the requirements of Regulation 87 of the Education and Care Services National Regulations. This template captures all mandatory details including child information, incident circumstances, time and date, actions taken, witness details, parent notification, and required signatures. The multi-step signing workflow ensures both the responsible person and parent/guardian review and sign the record.
Who fills in the incident, injury, trauma and illness record?
The incident, injury, trauma and illness record is completed by educators or the responsible person at the service. Staff open it on any device and sign with a service PIN, so there's no separate login to manage. It then moves through 2 signing steps — Responsible Person and Parent/Guardian — with each signature timestamped against the record.
Which Australian regulations does the incident, injury, trauma and illness record meet?
It is built around Reg 85, Reg 86 and Reg 87 of the Education and Care Services National Regulations. Reg 85 covers incident, injury, trauma and illness policies and procedures. Reg 86 covers notification to parents of incident, injury, trauma and illness. Reg 87 covers incident, injury, trauma and illness record. Every question the regulations require is already on the form.
Is the incident, injury, trauma and illness record the same as an incident report form?
Yes. Different services use different names for this form — it is also called incident report form, injury report form, accident report form and incident injury trauma and illness record. They all describe the same record, and this template covers it. You can rename it to whatever your service already calls it.
Can I change the questions on the incident, injury, trauma and illness record?
Yes. The template comes with 59 fields ready to go, but you can add, remove, reword or reorder anything in the drag-and-drop form builder, and add your own conditional logic and signing steps. Your changes only affect your service's copy.
Is the incident, injury, trauma and illness record free?
Yes — the incident, injury, trauma and illness record is free to use on the Childcare Forms free plan. No credit card is required to create an account and start sending it.
Ready to use it?
Create a free account, change anything you want, and send it to your first family. No credit card needed.