Sparkling Stars Childcare Centre: Incident Report & Risk Factors

This document presents an incident report from Sparkling Stars Childcare Centre, detailing an injury to a child named Issac. The report outlines the centre's details, the specifics of the incident including the date, time, and nature of the injury (abrasions and a cut to the arm). It documents the immediate response, including first aid administered by Trang, an assistant educator, and the subsequent call for medical assistance. The report also includes a detailed description of the event, noting that Issac was pushed by another child, Simon, and fell from the stairs. The report further identifies Trang as a witness and provides a space for additional information and signatures to verify the report's accuracy. This incident report serves as a record for internal review and potential safety improvements at the childcare centre.

Incident Report Form
1. Centre details
Location: Sparkling Stars Childcare Centre
Director: Contact phone:
Setting:
2. Incident details
Day: Date: Time:
Report completed by:
3. Type of incident (indicate which is applicable)
Personal injury Staff Customer  Child
Name of person injured: Issac
Part of Body Injured (if relevant): arm
Nature of injury sustained:
 Abrasions, scrapes
Bite
Broken bone/fracture
Bruise
Burn
Concussion
 Cut
Rash
Sprain
Swelling
Other (please specify)
Approximate size/colour of injury:
2 cm
Damage to goods (please specify):
Sparkling Stars Incident Report Form V1.0 – Produced 30 August 2024
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© Commonwealth of Australia 2012, Licensed under Creative Commons Attribution-ShareAlike 3.0 Australia License

No
 Assault Staff Customer Other
(please specify):
Vandalism
Robbery/break-in (also complete security incident report form)
Equipment failure/damage (please specify):
No
4. Response to incident (indicate which is applicable)
 First aid treatment administered(please specify what/by whom etc):
Yes
 Medical treatment administered (please specify where/by whom etc):
Trang took Issac to firstaid aim then called for medical help.
Assistance sought: (please specify
type)
 Ambulance Police Counsellor
Equipment shut down (please specify what/when etc):
No
Centre closed (please specify exact time):
Repair person contacted (please specify whom):
5. Other information
Sparkling Stars Incident Report Form V1.0 – Produced 30 August 2024
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© Commonwealth of Australia 2012, Licensed under Creative Commons Attribution-ShareAlike 3.0 Australia License

Who witnessed the incident? (please use full name, details of staff’s job title where applicable, and
telephone number/s):
Trang was the assistant educator who was hanling the kids. Her job is to take care of the activities of
kids ,their schedule is properly followed or not.
NOTE: Be specific. Describe in detail what actually happened, stating the facts in a clear and precise
manner. Include exact location of incident, factors involved and any other details that may be beneficial. A
drawing of the centre layout, identifying where the incident occurred, would be useful.
Trang noticed that a group of children playing and suddendly they had a quarrel among themselves.
Simon pushed Isaac and he fell from the stairs. Issac was worried watching his blood o his fingers. He got
hurt in his arms and he had abrasio for about 2 centimetres long and cut for half a centimetre long .
6. Other information
This report was compiled by (full name, title and contact telephone): On (date/time):
This report is a true and accurate summary of the incident that occurred (please sign):
Sparkling Stars Incident Report Form V1.0 – Produced 30 August 2024
Page 3 of 3
© Commonwealth of Australia 2012, Licensed under Creative Commons Attribution-ShareAlike 3.0 Australia License