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How to use or fill out DHS-4959-ENG with our platform
- Click ‘Get Form’ to open the DHS-4959-ENG in the editor.
- Begin by entering the 'Name of program' and 'Program license number' at the top of the form. This identifies your child care center.
- Fill in the 'Address' and 'Name of licensor' fields to provide contact information for your licensing authority.
- Record the 'Date of report', 'Date of injury/incident', and 'Date program notified of medical or dental care'. Accurate dates are crucial for compliance.
- Indicate the 'Time of day injury/incident occurred' to give a clear timeline of events.
- Enter the 'Name of child' and their 'Age'. This personalizes the report and ensures it pertains to the correct individual.
- In the section labeled 'Describe what happened (how, what, where)', provide a detailed account of the incident. Clarity is key here.
- Document any actions taken in response to the incident in the 'Action taken' field.
- Finally, specify 'To whom it was reported' and complete with your name and title in the 'Report completed by' section.
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See more DHS-4959-ENG versions
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4.5 Satisfied (21 Votes) |
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