Get Dc Unusual Incident Report Form 2019-2025

The DC Unusual Incident Report Form is crucial for reporting any unusual events that may impact the health, safety, or welfare of enrolled children. This guide will provide you with step-by-step instructions on how to complete the form online effectively.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. In Part I, Recorded By, fill in your information in the provided fields. Start with your name as the person reporting the incident, the facility name where the incident occurred, your title or position, and the facility’s address. Include your home telephone number and whether you are the director or owner of the facility. Complete the date and time you are reporting the incident, your office number, and your cell number.
3. Move to Part II, Incident Information. Start by entering the date and time the incident occurred. Next, specify the date you are reporting the incident. Indicate the type of incident, selecting from accident, injury, or unusual occurrence. If there was suspected abuse or neglect, select yes or no and indicate whether Child Protective Services (CPS) was contacted.
4. Continue filling out the incident location address in the provided field. For persons involved, indicate if they are an adult or child and provide necessary details including the child’s age, name, and home telephone number.
5. In Part III, describe the incident in detail. Clearly outline who was involved, what happened, where it occurred, and how the situation transpired. If you require more space, you may attach a separate sheet for additional information.
6. For Part IV, What Actions Were Taken and By Whom, provide the necessary details. After completing the form, ensure you sign and date it.
7. Finally, submit your completed form by faxing it to the Licensing and Compliance Unit at 202-727-7295 or email it to OSSE.ChildcareComplaints@dc.gov for processing.

Complete your incident report online to ensure timely processing and compliance.