
OCFS4436 (5/2014) FRONTIER YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICESINCIDENT REPORT FOR CHILD DAY CARE INSTRUCTIONS This form may be used to maintain a record of illnesses or injuries of a.
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How to fill out the NY OCFS-4436 online
Filling out the NY OCFS-4436 is essential for keeping accurate records related to incidents in child day care settings. This guide provides step-by-step instructions to help you complete the form with clarity and accuracy.
Follow the steps to fill out the NY OCFS-4436 form online:
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter today’s date in the designated field.
- Input the license or registration number associated with your child care program.
- Fill in the program name as it appears on your licensing documents.
- Provide the name of the child involved in the incident, ensuring to print the full first and last name.
- Record the child's date of birth in the specified section.
- In the 'Details of Incident' section, include the date, time, and exact location where the incident occurred.
- Document any injuries in the corresponding field, adding a full description of all marks, bruises, or abrasions noted.
- Describe any medical services or treatment that was provided, ensuring to list who administered the treatment.
- Proceed to fill out the caregiver details, including their full name and dates.
- Fill in the times of involvement, marking AM or PM as appropriate.
- Include the names and details of any witnesses to the incident, ensuring to document their full names and signatures.
- Note the notification details of the parent or guardian, including their full names and signatures.
- Record who notified the Office of Children & Family Services, including their full name and signature.
- Finally, save your changes, and choose to download, print, or share the completed form as needed.
Complete your NY OCFS-4436 form online today to ensure proper incident reporting.
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