Hi, welcome to silkysteps. There's an
example reflective sheet here that you can use & adapt to accompany a copy of a working accident and injury / incident form that your setting uses.
The layout of your setting's incident form ought to cover the necessary legal requirements and your reflective account should detail your part in the incident, why you did what you did, how you did it, what was good about it, what went wrong, why it went wrong and how you'd improve it next time - that should encompass all the possible criteria.
http://www.silkysteps.com/forum/showthread.php?t=6065
Best wishes