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Complete in report Sections I, II and/or III as appropriate. UNUSUAL EVENT OR INCIDENT: Unusual incidents include resident abuse, unexplained absences, or anything that affects the physical or emotional health or safety of any resident and epidemic outbreaks, poisonings, catastrophes, facility fires or explosions.

Contact your Licensing Officer or online Duty LO at 604-587-3936.

What is the unusual incident injury report form? 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.

An incident report is a formal recording of the facts related to a workplace accident, injury, or near miss. Its primary purpose is to uncover the circumstances and conditions that led to the event in order to prevent future incidents.

Common Types of Incident Reports Workplace. Workplace incident reports detail physical events that happen at work and affect an employee's productivity. ... Accident or First Aid. ... Safety and Security. ... Exposure Incident Report.

A daycare incident report should include: The name of the daycare. The childcare consultant. The injured child's name and age. The cause of the injury. The date, time, and location of the incident. The locations of any injuries the child suffered. The types of injuries the child suffered.

Incident Report Sample Walkthrough: A Step-by-Step Guide Step 1: Provide Fundamental Information. ... Step 2: Take Note of Any Damages and Injuries. ... Step 3: Identify Affected Individual(s) ... Step 4: Identify Witnesses and Take Their Statements. ... Step 5: Take Action. ... Step 6: Close Your Report.

The rule of thumb is that any time a patient makes a complaint, a medication error occurs, a medical device malfunctions, or anyone—patient, staff member, or visitor—is injured or involved in a situation with the potential for injury, an incident report is required.