My Ouch Report - Step By Step Child Care



My Ouch Report

Date: ______________ Time: ______________

Dear Parent,

This is to report that ________________________________ got hurt today.

Injury Details: ____________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Treatment: _______________________________________________________________

_________________________________________________________________________

Please sign and return this notice. Thank You.

Parent’s Signature ________________________________________________________

Caregiver’s Signature______________________________________________________

My Ouch Report

Date: ______________ Time: ______________

Dear Parent,

This is to report that ________________________________ got hurt today.

Injury Details: ____________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Treatment: _______________________________________________________________

_________________________________________________________________________

This Notice is for you to keep.

Caregiver’s Signature________________________________________________

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