Unusual Incident/Injury Report California: LIC 624 form

Form Template

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.

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This form includes all the detailed information necessary to complete form LIC 624.

Use this health and safety form of each child at day care to promote quality community care. As child care providers, uphold the personal rights of each client in care facilities through meeting California department reporting requirements. Create an unusual incident report to facilitate a medical assessment of the child.

Since the form is available for an iPhone, iPad, and Android device, all members of child care centers can use it to create an incident report. You are able to add information about the facility, client's name and address, and type of incident or injury that has occurred. All information you add is accessible on the secure GoCanvas Cloud and should be reviewed by an authorized representative before sending the incident report form to all necessary agencies. You can also print a PDF file to save a copy for your records.

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