Follow the steps to fill out the form online:

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Enter today's date in the designated field to document when the report is being completed.
3. Indicate the nature of the report by selecting either 'Accident' or 'Incident.' Specify the date and time of the occurrence using the appropriate fields.
4. Fill in the provider or center name, phone, and address to identify where the incident took place.
5. Include the name of the person completing the report and their title in the respective fields.
6. Document the first and last names, ages, and types of facilities of the individuals involved or who witnessed the incident.
7. Provide a detailed description of the accident or incident using complete sentences. If additional space is needed, attach extra paper.
8. Answer whether medical services were required, and if so, describe the treatment and outcome.
9. State whether the incident was handled appropriately, offering an explanation if it was not.
10. Notify if the Child Abuse Hotline was contacted in cases of suspected child abuse and provide the Registry Counselor’s name, if applicable.
11. Indicate if there was any legal action or an arrest made, describing the action taken if applicable.
12. Confirm if Pinellas County Child Care Licensing was notified and if the parent or guardian was immediately informed.
13. Assess whether the parent or guardian expressed satisfaction with how the incident was managed, and provide details if the answer is no.
14. Determine if a change in procedure is necessary to prevent similar incidents in the future and explain your preventive measures.
15. Once all sections are complete, save your changes, and prepare to submit the form by faxing it, uploading it to the Provider Portal, or mailing it to the Early Learning Coalition of Pinellas County.

Take the next step by completing the FL Early Learning Coalition SR-61F-19 form online to ensure timely reporting of any unusual incidents.