This prospective study examined characteristics of school-related injuries in grades K-6 and children's perceptions regarding prevention and environmental influences. Injuries were most likely to occur on the playground, were most frequent for first and second graders, and for boys. Only 30% of the sample perceived that they could have prevented their injury. This perception was more frequent for children in higher grades. Fifty percent perceived an environmental influence. The Health Promotion Model was used as the theoretical framework to guide this investigation and provide implications for practice. School nurses are in an ideal position to counsel children on taking responsibility for their safety through preventive thinking.