Get Wi Dcf-f-cfs0055-e 2021-2025

The WI DCF-F-CFS0055-E form is designed for reporting incidents in regulated child care settings. This guide provides clear, step-by-step instructions on how to complete the form online, ensuring compliance with Wisconsin's regulations.

Follow the steps to fill out the incident report form online.

1. Click ‘Get Form’ button to access the form and open it in your preferred digital environment.
2. Begin by providing the child care center or certified provider information. This includes the name of the facility, provider number, and a telephone number for contact.
3. Next, fill out the child information section. Include the child's name, birthdate formatted as mm/dd/yyyy, and home telephone number.
4. Proceed to the parent or guardian information part. Here, detail the names, home and work telephone numbers of both parents or guardians, along with their address (street, city, state, and zip code).
5. Document the date, time, and description of how the parent(s)/guardian(s) were informed of the incident.
6. In the incident information section, specify the date and time of the incident, indicating whether it occurred in the morning or afternoon, and identify the location (indoors, outdoors, in a vehicle, or other).
7. List the names of any adult witnesses present at the time of the incident. Provide a thorough description of the incident, detailing the injury's nature and extent, the activity the child was engaged in, and any actions taken post-incident, such as first aid.
8. Include details regarding any toys or equipment involved in the incident, specifically the brand name, type, and age rating.
9. Document any medical information, including how the center/provider was informed that medical evaluation was sought, as well as the hospital or clinic's name and address.
10. Finally, provide the name and title of the center representative or certified provider, along with their signature and the date signed.
11. Review all entries for accuracy and completeness. Once verified, you can save your changes, download the form, print it, or share it as required.

Complete your documents online today for a smooth and compliant experience.