01. Edit your lic624 online
Type text, add images, blackout confidential details, add comments, highlights and more.
Form LIC 624B Unusual Incident/Injury Report For Family Child ... 2026
Here's how it works
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send unusual incident report via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out Form LIC 624B Unusual Incident/Injury Report For Family Child Care Home
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
- Start by clicking ‘Get Form’ to open the LIC 624B in our editor.
- Fill in today’s date at the top of the form, followed by the facility name and license number.
- Enter the licensee’s name and facility address accurately to ensure proper identification.
- List the names and birth dates of each child involved in the incident, along with their gender and primary language.
- Document the date and time of the incident or injury, as well as when parents were notified.
- Select the type of incident or injury from the provided options, ensuring you check all that apply.
- Provide a detailed description of what happened and any injuries sustained, including physician details if applicable.
- Indicate how this incident will be prevented in the future and list any agencies notified about the incident.
- Complete your contact information at the bottom of the form before submitting it for review.
Utilize our platform to streamline your document editing process for free!
See more lic624 versions
We've got more versions of the lic624 form. Select the right lic624 version from the list and start editing it straight away!
Security and compliance
At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.
providers in licensed child care settings can use the unusual incident injury report form to report
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
Dec 4, 2025 LIC 624B, Unusual Incident/Injury Report Family Child Care Home Emergency/Disaster Preparedness Related Resources Emergency Preparedness.Read more
Custom-Configuration Is OurTrademark. From day one, Power Computing has believed in giving the Mac OS market a definitive choice.Read more