Get Dhr Incident Intake Report Form

Completing the Dhr Incident Intake Report Form online is a crucial step in reporting incidents for residential child care facilities. This guide will help you navigate through each section of the form to ensure all necessary information is accurately captured.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the Dhr Incident Intake Report Form and open it in your browser.
2. Enter the facility information: Fill in the facility ID number, date, satellite location, facility name, license number, site address, city, phone number, zip code, county, and email address.
3. Complete the reporter section: Provide your first and last name, middle initial, email, phone number, and job title.
4. Indicate the reason for the report: Check all applicable boxes related to the incident, such as physical abuse, sexual abuse, serious injury, and more.
5. If applicable, fill in the CPS notification section: Include the name, county, office number, and date of the report for all incidents involving physical or sexual abuse.
6. Document child/resident details: Input the child's first and last name, date of birth, gender, date of placement, and address. Ensure all fields are accurately filled out.
7. Provide information about the parent or guardian: Include their first name, last name, county of custody, phone numbers, and address.
8. If applicable, fill in the foster parent or adoptive parent section with their names and contact information.
9. List any witnesses to the incident, including their name, title, and contact information.
10. Detail the incident: Include the date, time, location, injury details, and a description of how the injury occurred.
11. Complete the summary of the incident: Provide a comprehensive account of who was involved, what happened, where and when it took place, and efforts to prevent further incidents.
12. Review all sections for accuracy before saving or submitting: Ensure all information is correct and complete.
13. Once completed, save your changes, and download, print, or share the form as needed.

Complete the Dhr Incident Intake Report Form online today to ensure proper documentation of incidents.