Student Injury Reporting
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For school personnel, including Nurses, Athletic Directors, Coaches, Secretaries, School Principals and Program Directors, and District staff supervising student activities.
When a student is injured during the school day, or during a school activity but outside of regular school hours, please follow the steps outlined on the Student Injury Reporting Procedure. The District’s two student injury forms – the District Accident/Injury Parent Notification Form (“AIPN Form”), and the AG Administrators Supplemental Health Insurance Claim Form (“AG Claim Form”) – are able to be completed electronically.
Please contact Marla Maldonado with any questions: (585) 262-8412; Marla.Maldonado@rcsdk12.org
Forms and Documents
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Student Injury AG Claim Form
Student_Injury_AG_Claim_Form_Rev_08_2021 PDF 10-2021.pdf 795.87 KB (Last Modified on October 13, 2021) -
Accident-Incident Parent Notification (AIPN) Form
Student_Injury_Accident_Incident_Parent_Notification_AIPN_Form_Rev_04_2016 PDF 10-2021.pdf 247.86 KB (Last Modified on October 13, 2021)