Get Wa Dcyf 15-941 2019-2025

Filling out the WA DCYF 15-941 form, also known as the Child Care Injury/Incident Report, is essential for early learning providers to document incidents or injuries that occur while children are in care. This guide provides step-by-step instructions to ensure accurate completion of the form online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the WA DCYF 15-941 form and open it in the editor.
2. Enter the child's name in the designated field. This ensures proper identification of the individual involved in the incident.
3. Complete the provider's name and ID to identify the facility responsible for the child's care.
4. Input the child's age to provide context regarding the level of care necessary during the incident.
5. Fill in the date and time of the incident, specifying whether it occurred in the a.m. or p.m. This information is crucial for accuracy in reporting.
6. Indicate where the incident occurred by checking 'Indoors' or 'Outdoors.' This helps in assessing the environment in which the incident took place.
7. Document any treatment provided to the child while in care, detailing who administered it. This includes both staff members and any witnesses present.
8. Check all applicable situations that required an emergency response from services such as 911 or other relevant authorities.
9. List any serious injuries that occurred, selecting from the provided options, which range from severe bleeding to poisoning.
10. Provide a brief description of the injury or incident, including specific details about the location where it occurred.
11. Record the contact information for the parent or guardian, including the date and time they were notified, as well as the method of contact.
12. Additionally, document if the licensor was contacted, including details similar to the parent/guardian section.
13. Include any comments made by the parent or guardian regarding the incident.
14. Obtain the parent/guardian's signature along with the date, and ensure the licensee or staff member also signs with the corresponding date.
15. Review all entered information for accuracy before proceeding to save, download, print, or share the form as needed.

Complete your WA DCYF 15-941 form online today to ensure proper incident documentation.