LIC 624 - Unusual Incident/Injury Report Author: CA Dept. of Social Services Subject: LIC 624 Form Created Date: 19990610132417Z
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LIC 624, Unusual Incident/Injury Report
Forms, Policies, and Checklists; Disaster Preparedness ... LIC 624, Unusual Incident/Injury Report. Emergency/Disaster Preparedness. English Spanish ; LIC 624, Unusual Incident /Injury ... 80.58 KB) Updated November 2022, UCSF California Childcare Health Program. Print this page. Related Resources. Wildfires Fact Sheet. Air Quality ...
Title: LIC 624 - Unusual Incident/Injury Report Author: CA Dept. of Social Services Created Date: 4/20/2021 3:48:03 PM
LIC 624B (8/08) PAGE 2 of 2 18. DATE THE PARENT/AUTHORIZED REPRESENTATIVE OF THE AFFECTED CHILD WAS NOTIFIED: 17. NAME AND TELEPHONE NUMBER OF PARENT(S), OR AUTHORIZED REPRESENTATIVE: GENERAL INSTRUCTIONS FOR COMPLETION 1. Enter the facility number as shown on the license 2. Enter the licensee’s …
Form LIC624 - Fill Out, Sign Online and Download Fillable PDF ...
Fill out and download the LIC624 Unusual Incident/Injury Report form for California online in PDF format. Easily report any unusual incidents or injuries with this free template.
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LICENSEE MUST REPORT THE DEATH OF A CLIENT OF ANY CAUSE, REGARDLESS OF WHERE THE DEATH OCCURRED. INSTRUCTIONS : NOTIFY LICENSING AGENCY, PLACEMENT AGENCY AND RESPONSIBLE PERSONS, IF ANY, BY NEXT WORKING DAY. SUBMIT WRITTEN REPORT WITHIN 7 DAYS OF OCCURRENCE. RETAIN COPY OF …
Notify parent(s), guardian, or authorized representatives of child(ren) in care. Notify Licensing by telephone, fax, or e-mail before end of next working day. If reported by telephone, submit written report within 7 calendar days of the incident/injury to Licensing. Keep a copy of the report in the child’s facility file. 4. FACILITY NAME: 5. 6.
Unusual Incident/Injury Report (LIC 624) - SETA Head Start
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Incident Report LIC 624 Form – Fill Out and Use This PDF
The Incident Report LIC 624 form is a crucial document used by the California Department of Social Services Community Care Licensing Division. It is designed for reporting unusual incidents or injuries that occur within licensed care facilities, detailing steps taken immediately after the incident and specifying follow-up actions.
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