1. Injury and Incident Report
What You Need to Know

2. Injury Reporting
An injury report is filled out anytime an injury occurs during your After School program. This applies to any:
Students
Staff (including you, Certificated & Classified)
Volunteers (adult and middle/high school)
Subcontractors who are offering services in your program
Visitors/Parents

4. Incident Reporting Students
An incident report is filled out anytime criminal activity, bullying, or fighting occurs during or relation to your After School Program. CPS reporting involving an After School incident also warrants an incident report. CPS reporting involving a student’s caretaker does not.
Incident reports apply to:
Students
Staff (including you, Certificated & Classified)
Volunteers (adult and middle/high school)
Subcontractors who are offering services in your program
Visitors/Parents

6. Common Mistakes Not enough details.
Missing signatures (Site Coordinator, Reporting Person, CBO Administrator, Principal)
Missing Parent Notification information.
Missing corrective action details (meeting with parents? RP?)

7. Following Up
Speak to student’s parents/guardian on the day the injury/incident occurs. Severe injuries/incidents require a call home immediately.
Check in the next day to see how the student is doing.
Make sure you speak to parents/guardians of ALL students involved.
Your CBO Director and Principal needs to be informed.
Handle any situation ASAP! Don’t wait!

8. Things to Remember
Forms can be found on our website under Resources Forms
State the basic facts, please do not use any words that reflect what you think the intentions of the parties involved were.
Double check to make all important sections on the form is complete.
Signatures! Please make sure everyone signs on the bottom!
Scan and the form to me, Alice Tam at
If you are unable to get your Principal’s signature right away, include your Principal on the you send me so that I know he/she is aware of the situation.
Follow up!

9. Questions? When in doubt, just ask!
Check in with your ExCEL contact person or contact me directly at or x1026