Get Ca Lic 624b 2008-2026

The CA LIC 624B form, also known as the unusual incident/injury report for family child care homes, is a crucial document for reporting specific events and incidents involving children in care. This guide provides straightforward, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the CA LIC 624B online.

1. Press the ‘Get Form’ button to access the CA LIC 624B form and open it in the editing interface.
2. Enter the facility license number as displayed on your license document.
3. Input the name of the licensee exactly as it appears on the license.
4. Provide the facility name as it is listed on the license.
5. Fill in the facility address, including street number, city, and zip code.
6. List the names of the child or children involved in the incident.
7. Include the birth date or age of each child.
8. Indicate the sex of each child using M for Male or F for Female.
9. State the admission date for each child into the family child care home.
10. Specify the primary language spoken by the child or their parent.
11. Record the date and time of the incident or injury.
12. Select all applicable events that need reporting from the provided checklist regarding the incident.
13. Describe in detail what occurred, including names of involved persons and any relevant medical findings.
14. Outline steps taken to prevent a similar incident or injury in the future.
15. Provide the name of the physician or health care provider involved, if applicable.
16. Enter the telephone number of the physician or health care provider.
17. Input the name and telephone number of the parent(s) or authorized representative(s).
18. Record the date the parent or authorized representative was notified about the incident.
19. Check all agencies that were notified regarding the incident.
20. List the names of individuals contacted at the agencies.
21. Enter the telephone or fax number for each agency you contacted.
22. Sign the form as the licensee.
23. Include your telephone number.
24. Document the date you signed the report.
25. Review all entries for accuracy before finalizing the report.

Complete your CA LIC 624B online today to ensure timely reporting and compliance.