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UNUSUAL INCIDENT/INJURY REPORT - FAMILY CHILD CARE HOME 2026
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How to use or fill out UNUSUAL INCIDENT/INJURY REPORT - FAMILY CHILD CARE HOME
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering today’s date, facility license number, licensee’s name, facility name, and address in the designated fields.
- List the names of the child(ren) involved along with their birth dates and gender. Ensure accuracy for proper documentation.
- 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.
- In the description fields, provide a detailed account of what happened and describe the injury specifically. Include names of individuals involved if applicable.
- Document how this incident will be prevented in the future to enhance safety protocols within your care environment.
- Finally, fill out the contact information for agencies notified and ensure that all required signatures are completed before submitting.
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Related links
Apr 27, 2026 English, Spanish. LIC 624B, Unusual Incident/Injury Report Family Child Care Home (pdf; 127.96 KB) LIC 624B (SP), Reporte de incidenteRead more
by W Nussbaum 2015 Cited by 7 The tool is appropriate for use with youth being charged with an act of family violence against a parent or caregiver. There may be occasions, however, when theRead more
SUBMIT WRITTEN REPORT WITHIN 7 DAYS OF OCCURRENCE. RETAIN COPY OF REPORT IN CLIENTS FILE. NAME OF FACILITY. FACILITY FILE NUMBER. TELEPHONE NUMBER.Read more