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Dss incident form 2026

The document is a Critical Incident Reporting Form from the North Carolina Division of Social Services, designed for agency staff to report incidents involving clients within residential facilities or foster homes. It outlines the necessary information to be collected, including general details about the agency and client, specifics of the incident, and any notifications made to authorities. The form must be submitted within 72 hours and includes sections for narrative descriptions of incidents, types of incidents, and safety plans.

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Click ‘Get Form’ to open the dss incident form in the editor.
Begin by filling out the 'General Information' section. Enter your agency name and address, then select either option A or B based on whether you are reporting a residential facility or foster parent.
Provide client details including their name, age, and placement date. Ensure to include the parent/guardian's information and the date of the incident.
In the 'Type of Incident' section, check all applicable items that describe the incident. Be thorough to ensure accurate reporting.
Complete the 'Narrative' section by detailing the circumstances surrounding the incident. Include relevant information about individuals involved and any safety plans implemented.
Finally, list any authorities notified regarding the incident in the 'Notification' section, ensuring all dates and names are accurately recorded.

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