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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES UNUSUAL INCIDENT/INJURY REPORT - FAMILY CHILD CARE HOME FACILITY LICENSE NUMBER LICENSEE NAME FACILITY NAME FACILITY ADDRESS Name of Child ren Involved Birth Date/Age 7. Sex M/F 8. Admission Date 9. Primary Language Date/Time of Incident/Injury 11. EVENT REPORTED TO THE DEPARTMENT CHECK ALL THAT APPLY a* Death of any child from any cause. b. Any injury to a child that requires treatment by a medical ...

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What are the 4 types of incident reports?

The 4 main incident reports that should be on your list are: Near Miss Reports. Near misses are events where no one was injured, but given a slight change in timing or action, someone could have been. ... Injury and Lost Time Incident Report. ... Exposure Incident Report. ... Sentinel Event Report.

What is an incident example?

The definition of an incident is something that happens, possibly as a result of something else. An example of incident is seeing a butterfly while taking a walk. An example of incident is someone going to jail after being arrested for shoplifting.

What is an example of an unusual incident?

Unusual Incident means incidents involving serious illness or accidents, death of an individual, injury or illness of an individual requiring inpatient or emergency hospitalization, suicide attempts, a fire requiring the services of a fire department, an act of physical aggression, or any incident requiring abuse ...

What is an unusual occurrence report?

The unusual occurrence report is a guide to walk through a thorough investigation for a root cause analysis. An unusual occurrence report is to be completed for all injuries/accidents or any situation/occurrence that could pose a safety risk to patients or staff.

Which people must be identified in the MUI report?

Also required to report MUIs are all providers who are contracted, certified, or licensed to serve persons with developmental disabilities, including all county board and developmental disabilities staff and contractors and anyone providing Medicaid waiver services.

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What is considered an unusual incident?

More Definitions of Unusual Incident Unusual Incident means an event or occurrence involving an individual that is not consistent with routine operations, policies and procedures, or the individual's care or service plan, but is not a major unusual incident.

What are three types of family child care homes are allowed by child care licensing in Colorado?

Small centers care for five to 15 children from 2 to 16 years old; large centers care for 16 or more children from 2½ to 16 years old. Large child care homes.

Which of the following types of reports must be reported by the child welfare?

\u201cWhat Must be Reported to CACI?\u201d The law requires child welfare agencies to make a CACI report to the CA DOJ whenever they substantiate an allegation of 1) physical abuse, 2) sexual abuse, 3) mental abuse, or 4) severe neglect.

How many categories of major unusual incidents are there?

There are nineteen types of incidents defined in the rule that are considered major unusual incidents.

Which of the following incidents must be reported to Child Care Licensing choose all that apply?

Unusual incidents, such as suspected child abuse and epidemic outbreaks, must be reported to licensing by phone, followed by a written report. You must also report any changes to your facility, including personnel changes, modifications to the facility, and address changes.

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What are three types of family child care homes are allowed by child care licensing in Colorado?

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Which of the following incidents must be reported to Child Care Licensing choose all that apply?

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