Get Wi Dcf-f-cfs0055-e 2016-2025

Completing the WI DCF-F-CFS0055-E form is essential for reporting incidents in regulated child care settings. This guide will provide you with a clear and supportive step-by-step approach to filling out this form online.

Follow the steps to effectively complete the form.

1. To start, press the ‘Get Form’ button to access the form and open it for editing.
2. In the 'Child Care Center / Certified Provider Information' section, enter the name of the facility or provider, along with the facility/provider number and telephone number.
3. Next, fill in the 'Child Information' section. Provide the child's name, birthdate (formatted as mm/dd/yyyy), and the home telephone number.
4. In the 'Parent / Guardian Information' area, input the names, home telephone numbers, work telephone numbers, and address of the parents or guardians.
5. Document the date, time, and description of how the parents or guardians were notified of the incident.
6. Proceed to the 'Incident Information' section. Indicate the date and time of the incident. Select whether the location was indoors, outdoors, in a vehicle, or another specified area.
7. List the names of adult witnesses and provide a detailed description of the incident, including the nature and extent of the injury, the activity during the incident, and any actions taken, such as first aid or clean up.
8. If applicable, note the brand name, type, and age rating of any toy or equipment involved in the incident.
9. In the 'Medical Information' section, record the date, time, and description of how the center/provider became aware that medical treatment was being sought.
10. Enter the hospital or clinic name, along with the physician’s name and the clinic's address.
11. Describe the medical treatment provided by the medical professional.
12. Finally, type or print your name and title in the 'Center Representative / Certified Provider Name and Title' section. Sign and date the form.
13. After completing the form, ensure to save your changes. You can then download, print, or share the form as needed.

Start filling out your documents online today for a seamless experience.