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Department of Social Services
Child care providers are required to report a child death or serious injury within 24 hours of the incident.
You can make a report by filling out the form below.
Incidents that require a report include, but are not limited to:
• The death of a child if the child died while in your care.
• A serious injury that results in the child getting professional medical treatment while in your care.
• The death of a child you care for if the child died of a contagious disease.
Death (Please Select).
Please type "N/A" if information is not available.
Date of Incident
Time of Incident
Name Of Provider
Child First Name
Child Last Name
Parent First Name
Parent Last Name