AGENCY: Davis County School District (Utah). Hill Field Elementary School

SERIES: 10147
TITLE: Student injury report
DATES: 1979-
ARRANGEMENT: Alphabetical by student's name

DESCRIPTION: This report is completed by school personnel immediately after a severe student injury and a copy is then submitted to the State Division of Family Health Services. An injury is considered severe if requires the loss of a half day or more of school or warranted medical attention or was required to be reported by district policy. The form includes child's name, parent's name, district name and number, school name and number, student's sex, birth date, grade, accident's date and time, number of days absent, action taken by school and parent, nature of injury, area affected, contributing factors, period, location of accident, activity, equipment, injury description, signature of person making report, title code, and principal's signature. The state's copy is retained for five years.

RETENTION

Retain for 4 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 09/1992

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years and then destroy.

APPRAISAL

Administrative Historical

This disposition is based on the administrative needs expressed by the school and meets the four year malpractice statute of limitation provisions (UCA 78-14-1 (1991)).

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