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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES UNUSUAL INCIDENT/INJURY REPORT FAMILY CHILD CARE HOME INSTRUCTIONS: 1. Notify parent(s), guardian, or.
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Unusual occurrence report example FAQ
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the exact location and/or address of the incident. the exact time and date of the occurrence. a detailed and clear description of what exactly happened. a description of the injuries.
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ing to GuideOne Insurance, an incident report is defined as, “Any time an accident happens that requires the injured child to stop normal activity and/or receive first aid or medical attention; an accident report form must be completed.
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UNUSUAL EVENT OR INCIDENT: Unusual incidents include resident abuse, unexplained absences, or anything that affects the physical or emotional health or safety of any resident and epidemic outbreaks, poisonings, catastrophes, facility fires or explosions.
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Incident Report Sample Walkthrough: A Step-by-Step Guide Step 1: Provide Fundamental Information. ... Step 2: Take Note of Any Damages and Injuries. ... Step 3: Identify Affected Individual(s) ... Step 4: Identify Witnesses and Take Their Statements. ... Step 5: Take Action. ... Step 6: Close Your Report.
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8 Items to Include in Incident Reports The time and date the incident occurred. ... Where the incident occurred. ... A concise but complete description of the incident. ... A description of the damages that resulted. ... The names and contact information of all involved parties and witnesses. ... Pictures of the area and any property damage.
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The unusual occurrence report is a guide to walk through a thorough investigation for a root cause analysis. An unusual occurrence report is to be completed for all injuries/accidents or any situation/occurrence that could pose a safety risk to patients or staff.
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What should be included in a daycare incident report? The name of the daycare. The childcare consultant. The injured child's name and age. The cause of the injury. The date, time, and location of the incident. The locations of any injuries the child suffered. The types of injuries the child suffered.
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What Information Do You Put in an Incident Report? Detailed description of the event with events listed chronologically. Witnesses or injured party statements. Injuries sustained by the person(s) as a result of the incident or the outcome. Actions taken immediately after the incident occurred. Treatments administered.
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