1. The Simple guide: completing A Student/visitor Injury/INCIDENT report
For KPBSD Staff Members

2. What is an Injury Report?
The Injury/Incident Report is an internal document which details an incident causing real or suspected harm/injury to a student or visitor while at school or at a school sponsored activity, regardless of time or location.

3. What is the Purpose?
The purpose of the Injury/Incident Report is to record how each KPBSD system functions and responds to an incident causing harm or injury.
The process is in order to:
Analyze accidents or injuries and examine preventative measures for the future.
Respond to insurance inquiries.
Respond to legal challenges.

4. In What Circumstances Should a Report be Completed?
An Injury/Incident Form should be completed in any of the following situations:
A serious injury occurs, regardless of whether medical attention is sought (especially to head, neck or spine.)
Emergency medical care is sought or the student seeks
additional medical follow-up
Injury is the result of an act of violence
or an altercation with another person
Injury results in missed attendance

5. Who is Responsible for Completion of the Report?
The staff person responsible for the student at time of incident is responsible for making sure the report is initiated and for signing as the person completing the report. The report is available online at:
If on-site at the time, the nurse will complete the assessment portion of the report and will later complete the follow-up portion.
If the nurse is not on-site at the time of the incident, the box for nurse available would be marked “No”; however, the nurse will still complete the follow-up.
In many schools, the nurse coordinates this process and enters data and statements provided by all involved. It is important to know your school’s practice.

6. What Goes in the Report? Basic demographic data Injury information
Your name
Description of accident
Type of injury and what part of the body was affected
Description of student activity at time of injury
Any unsafe acts or conditions
Safeguards in place and amount of supervision when injury occurred
Outcome of injury/accident
First aid provided
Witness identification and description of event
Notification of parent/guardian
Responder/Nurse report
Additional Follow Up
Dates and Signatures
Verification that a Myers-Stevens Form has been provided to parent/guardian

7. What Actions Should be Taken When There is No Nurse Available at the Time of an Incident?
The first and most important response is to provide proper first aid care according to the school’s emergency protocol.
Parents/guardians should be notified as soon as possible (note the time of this contact and who, specifically, was notified).
Part A of the Myers-Stevens insurance form should be filled out, signed by the administrator or “school official.” It should then be copied with original given (or mailed) to the parent and the copy filed at the school with the final incident report. The cover letter should accompany the Myer-Stevens form to the parent.

8. Actions To Take
If the event results in a 911 call or the student being taken to the emergency room, please contact Natalie Bates at as soon as possible.
Complete an Injury/Incident Report ents_parents.aspx?id=19736.

9. How is the Injury Report Accessed and Completed?
Go online to the KPBSD website.
Select Employees tab.
Select Accident/Injuries in the top left corner under Section Links.
Select Student/Visitor Injuries/Accident Forms 
You may wish to bookmark the address:
Print out a copy of the Accident Claim Form (Myers-Stevens insurance form). Fill out Part A of this form. Give to parent.
The cover letter should accompany the Myers-Stevens form. The nurse, administrator or secretary can print this personalized letter from PowerSchool.

10. Accessing and Filling Out the Report - continued
Fill out as many fields as possible (excluding nursing portions if you are not a nurse). Some fields are mandatory in order for the report to be submitted.
Fill in your KPBSD information just above the Submit button so that an electronic copy will be sent to your .
You must select the SUBMIT button in order to send the report electronically. The report will go to District Office and Risk Management.
Once submitted, you should receive an immediate automatic of this report back in your KPBSD in-box. If you do not, contact Natalie Bates at
The nurse will receive an electronic copy of the injury report.

11. Adding Information to the Report
If you receive a copy of a report via from the nurse (that s/he initiated) and you need to contribute information to the report:
Forward the back to the nurse in order to fill the fields.
Provide additional information as completely as possible. Your new comments should be entered in RED lettering. Make sure to add your initials to the end of each entry.
Send when complete.

12. What Happens with the Report after this Process?
If further information needs to be added to the report at any time subsequent to the initial report, it should be entered with RED lettering and forwarded to the nurse. The nurse will submit this information.
The nurse will complete follow-up notes in RED lettering as soon as information becomes available.
Once the report is complete, signatures will be gathered on the hard copy. Originals are to be kept in a file in the school or nurse’s office. The nurse will BizHub the signed report along with a signed copy of the Myers-Stevens form (Part A completed) to

13. What MUST be Given to Parents?
Myers-Stevens Insurance Form with Part A completed and signed by school official (administrator or nurse, etc.)
Cover letter regarding insurance coverage. This form letter may be printed by the nurse, administrator or secretary.

14. Accident/Injury Reports: A Summary
An injury/incident occurs. The school’s emergency response follows posted First Aid and Emergency Protocol guidelines.
The staff person responsible for the student at the time of the incident fills out first section of report and submits online or nurse begins report using information provided by the staff member who was responsible for the student at the time of the incident. Witnesses provide input to be included in report.
The person preparing the report records their name as originating form and includes names of witnesses, then submits report electronically to The nurse enters any additional data and completes the nurse’s portion of the form.
The parent must be provided with Myers-Stevens form (with Part A complete and signed) and the personalized cover letter printed from PowerSchool.
Follow up: New information is recorded in RED on ed electronic report. This report is ed to
Both the Injury/Incident Report and the Myers-Stevens Accident Claim form with Part A completed must be signed. They are then sent by BizHub to The original of the injury report and copy of the M-S form remain at the school in a locked file in either the nurse’s office or the administrator’s office.

15. Accident Report DO’S
DO present facts—i.e. describe adequate supervision by noting “2 coaches in room” or “teacher in hallway,” etc.
DO completely describe injured body part, including side of body affected.
DO describe incident in OBJECTIVE terms.
DO note correct times. Use your phone Directories function to find out the time parents/guardian was contacted.
DO identify safeguards in place (normal actions that keep students safe) such as “student aware of classroom rules” or “staff in hallway or parking lot” or “safety rules discussed with students at beginning of activity or semester,” etc.

16. More Accident Report DO’S
DO document care provided by everyone involved. Ask witnesses to write brief account and include in report.
DO enter information from all persons who can provide it.
DO ask for help! Your school nurse or administrator should be able to help you. Natalie Bates in District Office at is another great resource.

17. Accident Report DONT’S
DON’T use subjective language. Make it measurable.
DON’T embellish (“I wouldn’t be surprised if…,” “It seemed…,” “I think…,” “It appeared…”)
DON’T state things you are not certain of.
DON’T give extra information.
DON’T use terms that could imply inadequate supervision.
DON’T diagnose an injury.

18. Flow Chart for Injury/Incident Reporting