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Student Incident Form


1) The School Nurse or staff member (Coach) must complete the Student Accident Report when the situation arises. Copies need to be filed with: 
  • Students’ Parents 
  • School Nurses’ office 
  • School Business office 

2) The “Student Accident Insurance FAQ” sheet and “WellFleet Special Risk K-12 Claim Filing Instructions” letter should be sent home with the student/parents. 

3) The WellFleet Special Risk form is sent home with the student/parents. This form should only be completed by the students’ parents in the event that they require the schools’ accidental medical insurance policy to pay for related accident expenses. 

4) Questions regarding the procedure or forms should be made to the District Business Office, 548-6430. 

English: Accident Form

Spanish: Accident Form