LIC 624, Unusual Incident/Injury Report (PDF; 78.21 KB) LIC 624 (SP), Reporte de incidente inusual o lesin (pdf; 80.58 KB) CCHP is a program of the University of California San Francisco School of Nursing, Department of Family Health Care Nursing . An public State of Ohio website. Form LIC 624, Unusual Incident/Injury Report, is an document created for daycare providers that allows them to report unusual incidents and/or injuries to the appropriate California state agencies. You can use three available alternatives; typing, drawing, or uploading one. PDF INSTRUCTIONS : UNUSUAL INCIDENT/INJURY - California Department of Unusual Incident Report - Fill and Sign Printable Template Online 4~leCz4 *. Some examples of unusual incidents that must be reported include: [The host speaks, and the questions she asks are displayed on a white board.]. INSTRUCTIONS : NOTIFY LICENSING AGENCY, PLACEMENT AGENCY AND. LIC 624B (8/08) - Unusual Incident/Injury Report - Family Child Care Home LIC 624 LE (12/22) - Law Enforcement Contact Report LIC 625 (11/19) - Appraisal/Needs and Services Plan Unusual Incident Injury Report Form Lic624 - ReportForm.net How Many Children Can Attend a Family Child Care Home? The Incident Report Lic 624 Form is used to report an incident that could impact the safety or well-being of employees, patients, students and the general public. These reports are required of both family child care homes and centers. This form is designed to help you keep track of any and all incidents that take place, from property damage to customer accidents. Notify Licensing by telephone, fax, or e-mail before end of next working day. Add the PDF you want to work with using your camera or cloud storage by clicking on the. lic system are kept in good condition and are clean and tight. It can help in your memory space of the event's details and function as assistance to your claim. This Unusual Incident and Injury Report California: LIC 624 is a mobile form designed for daycare providers to report unusual incidents and/or injuries to the appropriate California State Agencies. unusual incident/injury report instructions : notify licensing agency, placement agency and responsible persons, if any, by next working day. Open the email you received with the documents that need signing. Press the button below to start editing your this form file. UNUSUAL INCIDENT/INJURY. Choose My Signature. Technology, Power of Provide the basic facts. _|/-Xe zhbJT}e Use this health and safety form of each child at day care to promote quality community care. Handbook, Incorporation You are able to add information about the facility, client's name and address, and type of incident or injury that has . This is where the Incident Report Lic 624 Form comes in. Recording an occurrence statement type is a crucial part of the protection software.
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