Incident Reporting Requirements
Licensed child care facilities are legally required to have policies and procedures for recording reportable incidents. Some states may have specific forms to use and reporting criteria that must be followed.
When an incident occurs, staff must take the following steps:
- Address immediate safety concerns.
- Notify the child’s parent or legal guardian.
- Alert the appropriate licensing office.
Reportable Incidents
- Medical emergencies
- Aggressive acts against self or others
- Unauthorized absences
- Stolen or damaged property
- Accidents and injuries
- Suspected abuse or neglect
Sample
Facility Name: [FACILITY NAME]
Location: [LOCATION]
Describe the Incident: [DESCRIBE THE INCIDENT]
Follow-up action taken: [FOLLOW-UP ACTION TAKEN]
- Child Name: [CHILD NAME] Age: [AGE] Parent/Guardian Name(s): [PARENT NAME(S)] Phone Number: [PHONE]
- Child Name: [CHILD NAME] Age: [AGE] Parent/Guardian Name(s): [PARENT NAME(S)] Phone Number: [PHONE]
- Child Name: [CHILD NAME] Age: [AGE] Parent/Guardian Name(s): [PARENT NAME(S)] Phone Number: [PHONE]
If yes, describe the injuries: [INJURY DESCRIPTION]
If yes, at what time? [TIME] ☐ AM ☐ PM
Name of person who contacted parent/guardian: [NAME OF PERSON]
Staff person in charge at time of incident: [NAME OF STAFF PERSON]
If yes, enter the witnesses’ names and contact info:
- Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL]
- Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL]
If yes, was a report filed? ☐ Yes ☐ No
Was medical treatment provided? ☐ Yes ☐ No ☐ Refused
If yes, where was medical treatment provided? ☐ On site ☐ Hospital ☐ Other: [OTHER]
Staff Member Signature: Date: [MM/DD/YYYY]\
Director Signature: Date: [MM/DD/YYYY]
Parent/Guardian Signature: Date: [MM/DD/YYYY]