Ooh, Reggio... may I snag the wording as well?
I have a basic form for any "notable" occasions. If there is a visible injury or the child was very distraught, it details the date, the time, the party/parties involved and a description of the events. There is a spot for "further action to be taken" as well. I sign, the parent signs, and it gets kept in the child's file.

































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