UNUSUAL INCIDENT/INJURY REPORT - FAMILY CHILD CARE HOME 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering today’s date, facility license number, licensee’s name, facility name, and address in the designated fields.
3. List the names of the child(ren) involved along with their birth dates and gender. Ensure accuracy for proper documentation.
4. Indicate the type of incident or injury by checking one or more applicable boxes. Be thorough in your selection to ensure all relevant details are captured.
5. In the description fields, provide a detailed account of what happened and describe the injury specifically. Include names of individuals involved if applicable.
6. Document how this incident will be prevented in the future to enhance safety protocols within your care environment.
7. Finally, fill out the contact information for agencies notified and ensure that all required signatures are completed before submitting.

Start using our platform today to streamline your form completion process for free!