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The document LDSS-4436 is an Incident Report form for Child Day Care used by the New York State Office of Children and Family Services. It serves to record incidents involving children, such as illnesses, accidents, or signs of abuse, and requires details about the incident, injuries, medical treatment provided, and notifications made to parents or guardians. The form also includes sections for witness information and staff signatures.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (160 Votes)
2011	4 Satisfied (24 Votes)

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What are the 5 rules of incident reporting?

What are the five rules of incident report writing? Timeliness: Always report the incident as soon as possible. Accuracy: Make sure all information provided is accurate and detailed. Completeness: Be thorough and provide all important details. Confidentiality: Handle sensitive and personal information carefully.

What are the three 3 requirements for writing an incident report?

Keep in mind that these three considerations are not to be confused with the three requirements for writing an incident report: The report must be factual and without assumption. An incident report must be accurate and without bias. The incident report must be complete.

How do you write a simple incident report?

How to write a workplace incident report Gather essential information. Describe the incident. Include injuries and damages. Interview witnesses. Identify contributing factors. Review company policies and procedures. Attach supporting documents. Maintain objectivity.

What are examples of incident reports?

8 Types Examples of Incident Reports at a Workplace Near Miss Report. Workplace Hazard Report. Minor Injury Report. Accident Report. Fire Incident Report. Equipment Failure Malfunction Report. Property Damage Report. Exposure Incident Report.

How to write a child incident report?

Sample Child Safety Incident After-Action Report Date of incident(s)/behavior(s): Number of children/youth involved: Ages and gender of children/youth involved: Description of incident(s)/behavior(s): (attach additional sheets as needed) How did the situation come to your attention? Who did the report/incident involve?

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How do you write a minor incident report?

What to include in a work incident report The date and time of the incident. The name of the witness or author of the report. A detailed description of the events. The names of the affected parties. Other witness statements or important information. The result of the incident.

Child incident report example 2025

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