Provider Unusual Incident
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    SR and VPK Provider Unusual Incident

  • What is an unusual incident?

    An unusual incident is any significant event involving the health and safety of children under the provider's care. Examples include:

    • accusations of abuse or neglect against the provider or provider's staff
    • injury of a child that requires professional medical attention at provider's site or written notification from the child's parent or guardian that the child received professional medical attention
    • notice of litigation that relates to provider's operation of SR or VPK services when the provider is named party or defendent

    SR and VPK providers are required to report unusual incidents as follows:

    1. Report (verbally or in writing) the incident no later than the close of business on the next business day following the incident
    2. Provide a written report of the incident within three (3) business days from the date of the incident
  • Date of Incident*
     - -
  • Type of Facility*
  • Did the incident occur in a school-age program?*
  • What program(s) was the involved child(ren) enrolled in?*
  • Were medical services required?*
  • Was the incident handled appropriately?*
  • If this was a child abuse incident, was the Child Abuse Hotline notified?*
  • Was law enforcement notified?*
  • Was DCF Licensing notified?*
  • Was the parent/guardian notified immediately?*
  • Was the parent/guardian satisfied with the way the incident was handled?*
  • Is a change in procedure necessary to prevent a recurrence?*
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