Incident Injury Illness Reporting Form - Ohio Department of Education 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I, which includes your program's name, address, license number, and the name of the person completing the form. This information is crucial for identifying the reporting program.
3. In Section II, provide detailed incident/injury report details. Start with the date and time of the incident, followed by the child's name and date of birth. Ensure you include names of staff witnesses and who provided first aid.
4. Indicate how many staff members were supervising at the time and whether the family was contacted. Fill in additional fields regarding the child's age group and hours spent in care.
5. Select all applicable types of injury from the checklist provided. Be thorough to ensure accurate reporting.
6. Document actions taken during or after the incident, including any medical assistance provided or if emergency services were contacted.
7. Finally, review your entries for accuracy before signing off on the form to complete it.

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