Get Unusual Incident/injury Report - Family Child Care Home

Filling out the Unusual Incident/Injury Report for a family child care home is crucial for ensuring the safety and well-being of children in care. This guide provides step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your digital interface.
2. Enter today’s date in the specified field. This is the date when you are completing the report.
3. Input the facility license number as it appears on your license.
4. Fill in the licensee’s name as displayed on the license.
5. Provide the name of the facility exactly as it is listed on the license.
6. Complete the facility address, including number, street, city, state, and zip code.
7. List the names of each child involved in the incident or injury in the designated section.
8. Enter the birth date for each child involved, using the month/day/year format.
9. Indicate the gender of each child by selecting 'M' for male or 'F' for female.
10. Specify the primary language spoken by the child, such as English or Spanish.
11. Record the date and time when the incident or injury occurred.
12. Document the date that the child's parent(s) were notified about the incident.
13. Provide the names and telephone numbers of the child’s parent(s) or guardians.
14. Select the type of incident or injury from the provided options, checking one or more boxes as applicable.
15. In the description field, clearly detail what happened during the incident. Include names of individuals involved, if relevant.
16. Describe the nature of the injury sustained during the incident.
17. If applicable, enter the name and contact information of the physician or medical provider who treated the child.
18. Describe how similar incidents will be prevented in the future.
19. Indicate any agencies notified regarding the incident. Provide the names of personnel contacted and their contact details.
20. Enter your name and contact information as the individual completing the report.
21. Finally, save your changes, and choose to download, print, or share the completed form as necessary.

Complete your Unusual Incident/Injury Report online today for the safety of the children in your care.