Get Az Infant Death Investigation Checklist 2017-2026

The AZ infant death investigation checklist is a crucial document required for the investigation of any death involving a child under 12 months old. This guide provides you with clear instructions on how to complete this important form online, ensuring that you accurately provide all necessary information.

Follow the steps to successfully fill out the AZ infant death investigation checklist

1. Click the ‘Get Form’ button to access the checklist and open it in your online editor.
2. Begin by entering the child’s details in the designated fields. Include their name, home address, incident address, date of birth, social security number (SSN), date of death, and estimated time of death.
3. Next, fill out the information for the mother or primary caregiver. This includes their name, SSN, address, driver's license number (DL#), date of birth, other names used, places they've lived in, and contact number. Indicate if they are a smoker or have a history of substance use.
4. Provide similar details for the father or secondary caregiver, ensuring that you capture all relevant data as listed in the form.
5. If there was a caregiver at the time of the child's death who is not a parent, include their information in the designated section, along with their relationship to the child and how long they cared for them.
6. Continue filling out sections relating to caregiver information. Complete columns identifying the primary and secondary caregivers, their ages, sex, employment status, and substance use history.
7. Document any prior child deaths related to the caregivers, detailing the causes if applicable. Mark accordingly whether the incident occurred in Arizona and if emergency services were contacted.
8. Answer questions about the child's circumstances at the time of death, including their activities and environment. Specify the time of scene discovery and any observations regarding the child’s appearance.
9. In the health information section, record the child's primary care physician, any medications, allergies, and immunization history.
10. Finally, complete the additional comments section and add your details as the person completing the form including your name, agency, contact information, and your signature.
11. Once all fields of the form are filled in accurately, review the document for any necessary corrections. You can then save your changes, download, print, or share the form as needed.

Complete the AZ infant death investigation checklist online today to ensure a thorough investigation.